Provider Demographics
NPI:1255580957
Name:REINHOLTZ, GABRIELA MERCEDES (DDS)
Entity type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:MERCEDES
Last Name:REINHOLTZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:MERCEDES
Other - Last Name:SARDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:12035 BAMMEL NORTH HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-4703
Mailing Address - Country:US
Mailing Address - Phone:832-286-1014
Mailing Address - Fax:
Practice Address - Street 1:12035 BAMMEL NORTH HOUSTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-4703
Practice Address - Country:US
Practice Address - Phone:832-286-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24823122300000X
IL019.027621122300000X
GADN013802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212877902Medicaid