Provider Demographics
NPI:1811081680
Name:GAVITO, EMMA L (DDS)
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:L
Last Name:GAVITO
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 1:4912 PADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PADRE ISLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78597-7343
Mailing Address - Country:US
Mailing Address - Phone:956-761-1012
Mailing Address - Fax:956-761-4447
Practice Address - Street 1:4912 PADRE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH PADRE ISLAND
Practice Address - State:TX
Practice Address - Zip Code:78597-7343
Practice Address - Country:US
Practice Address - Phone:956-761-1012
Practice Address - Fax:956-761-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice