Provider Demographics
NPI:1669902425
Name:HERRERA, GABRIELA ALICIA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:ALICIA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12065 FORSYTHIA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7171
Mailing Address - Country:US
Mailing Address - Phone:407-534-4999
Mailing Address - Fax:
Practice Address - Street 1:8200 ROBERTS DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-4147
Practice Address - Country:US
Practice Address - Phone:770-691-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNF0004021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADNF000402OtherGEORGIA BOARD OF DENTISTRY