Provider Demographics
NPI:1780736819
Name:NGUYEN, GABRIELLE D (DDS)
Entity type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6719
Mailing Address - Country:US
Mailing Address - Phone:404-761-1542
Mailing Address - Fax:404-761-1778
Practice Address - Street 1:1029 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6719
Practice Address - Country:US
Practice Address - Phone:404-761-1542
Practice Address - Fax:404-761-1778
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00117651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice