Healthcare Provider Details

I. General information

NPI: 1558854661
Provider Name (Legal Business Name): GABRIELA GARZA COVARRUBIAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S PRESTON ST
LOUISVILLE KY
40202-1701
US

IV. Provider business mailing address

3718 HUNTERS RIDGE DR
PROSPECT KY
40059-9240
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5663
  • Fax: 502-852-3364
Mailing address:
  • Phone: 502-408-3675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9890
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: