Provider Demographics
NPI:1457576118
Name:GEBEAU, WILLIAM Q (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:Q
Last Name:GEBEAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7963 DERSINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-1469
Mailing Address - Country:US
Mailing Address - Phone:951-315-9815
Mailing Address - Fax:
Practice Address - Street 1:7963 DERSINGHAM DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-1469
Practice Address - Country:US
Practice Address - Phone:951-315-9815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD85931223G0001X
CA561301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice