MEDICARE: E GABRIEL DMD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	39958	CA

General Provider Information

NPI Number	:	1154513265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E GABRIEL DMD, INC

Provider Business Mailing Address
First Line	:	615 E BROADWAY
Second Line	:	#102
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5113
Country	:	US
Telephone Number	:	562-624-0990
Fax Number	:	562-624-0950

Provider Business Practice Location Address
First Line	:	615 E BROADWAY
Second Line	:	#102
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5113
Country	:	US
Telephone Number	:	562-624-0990
Fax Number	:	562-624-0950

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. EMERENCIANA G GABRIEL
Credential	:	DMD
Telephone Number	:	562-624-0990

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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