Provider Demographics
NPI:1053923425
Name:GABRIELZADEH, GABRIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:GABRIELZADEH
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 1:19901 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2630
Mailing Address - Country:US
Mailing Address - Phone:818-992-7200
Mailing Address - Fax:818-992-7300
Practice Address - Street 1:19901 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2630
Practice Address - Country:US
Practice Address - Phone:818-992-7200
Practice Address - Fax:818-992-7300
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice