=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801127238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANA GABRIEL D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2010
-----------------------------------------------------
Last Update Date | 01/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2140 BELLMORE AVE
-----------------------------------------------------
City | BELLMORE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11710-5662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-785-4744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2140 BELLMORE AVE
-----------------------------------------------------
City | BELLMORE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11710-5662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-785-4744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 052109
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------