MEDICARE: DR. WILLIS P GABEL DDS, MS

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	1223E0200X	Endodontics	6359	WA

General Provider Information

NPI Number	:	1174606784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIS P GABEL DDS, MS

Provider Business Mailing Address
First Line	:	22500 SE 64TH PL
Second Line	:	SUITE 110
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-8111
Country	:	US
Telephone Number	:	425-427-1120
Fax Number	:	425-427-1125

Provider Business Practice Location Address
First Line	:	22500 SE 64TH PL
Second Line	:	SUITE 110
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-8111
Country	:	US
Telephone Number	:	425-427-1120
Fax Number	:	425-427-1125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	11/10/2008

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