Healthcare Provider Details

I. General information

NPI: 1548106529
Provider Name (Legal Business Name): EKATERINA GABASHVILI DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 MOORPARK ST
STUDIO CITY CA
91604-2112
US

IV. Provider business mailing address

11711 MOORPARK ST
STUDIO CITY CA
91604-2112
US

V. Phone/Fax

Practice location:
  • Phone: 818-505-1211
  • Fax:
Mailing address:
  • Phone: 818-505-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: EKATERINA GABASHVILI
Title or Position: DENTIST
Credential: DMD
Phone: 323-215-8426