Healthcare Provider Details

I. General information

NPI: 1124135892
Provider Name (Legal Business Name): GABRIELLE MAHLER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 S DURANGO AVE
LOS ANGELES CA
90034-1116
US

IV. Provider business mailing address

1925 S DURANGO AVE
LOS ANGELES CA
90034-1116
US

V. Phone/Fax

Practice location:
  • Phone: 201-349-8373
  • Fax:
Mailing address:
  • Phone: 201-349-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number59018
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDIO2322900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number052087-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: