Healthcare Provider Details

I. General information

NPI: 1831809037
Provider Name (Legal Business Name): GABRIELLE GIEBELSTEIN QDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CLINTON ST
IOWA CITY IA
52240-4105
US

IV. Provider business mailing address

3332 WESTWOOD DR NW
CEDAR RAPIDS IA
52405-1349
US

V. Phone/Fax

Practice location:
  • Phone: 319-358-4824
  • Fax:
Mailing address:
  • Phone: 319-640-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberQDA-14735
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: