Healthcare Provider Details

I. General information

NPI: 1609088541
Provider Name (Legal Business Name): ANA M GAMA DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 WHITTIER BLVD STE D
LOS ANGELES CA
90022-4661
US

IV. Provider business mailing address

647 EAST E STREET STE 103
ONTARIO CA
91764
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-2008
  • Fax: 844-361-2102
Mailing address:
  • Phone: 909-986-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD48269
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANA M GAMA
Title or Position: PRESIDENT
Credential: DDS
Phone: 909-986-1003