Healthcare Provider Details

I. General information

NPI: 1558047266
Provider Name (Legal Business Name): GABRIELLA HICHAM BAYDOUN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 PARK ST N APT 406
ST PETERSBURG FL
33709-6326
US

IV. Provider business mailing address

5775 PARK ST N APT 406
ST PETERSBURG FL
33709-6326
US

V. Phone/Fax

Practice location:
  • Phone: 727-265-7125
  • Fax:
Mailing address:
  • Phone: 727-265-7125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32054
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN32054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: