Healthcare Provider Details

I. General information

NPI: 1194733956
Provider Name (Legal Business Name): TIMOTHY MARK GABE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LONGFELLOW PLACE SUITE 205
BOSTON MA
02114
US

IV. Provider business mailing address

5 LONGFELLOW PL
BOSTON MA
02114-2839
US

V. Phone/Fax

Practice location:
  • Phone: 617-742-3525
  • Fax: 617-742-6911
Mailing address:
  • Phone: 617-742-3525
  • Fax: 617-742-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number15626
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: