Provider Demographics
NPI:1831360973
Name:GAVALDON, IRMA (DDS)
Entity type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:
Last Name:GAVALDON
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 1:8505 NAVAJO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2001
Mailing Address - Country:US
Mailing Address - Phone:714-742-7248
Mailing Address - Fax:
Practice Address - Street 1:8505 NAVAJO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-2001
Practice Address - Country:US
Practice Address - Phone:619-828-1657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60022122300000X
MI29010193381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382406558OtherTAX ID