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General NPI Number Information
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NPI Number | 1578457735
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Entity Type | Individual
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Provider Name | GABRIELLE KATHERINE NELSON
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Gender | Female
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 4710 PUDDLEDOCK RD STE 200
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City | PRINCE GEORGE
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State | VA
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Zip | 23875-1269
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Country | US
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Telephone | 804-526-4822
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Fax |
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Provider Business Mailing Address
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Address Line | 5108 BROMLEY LN
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City | RICHMOND
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State | VA
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Zip | 23226-1535
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Country | US
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Telephone | 443-944-7140
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401419481
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License Number State | VA
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