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General NPI Number Information
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NPI Number | 1861640625
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Entity Type | Individual
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Provider Name | GABRIELA TATARU WILSON DMD
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Gender | Female
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Dates
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Enumeration Date | 09/05/2008
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 3727 EASTON MARKET
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City | COLUMBUS
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State | OH
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Zip | 43219-6023
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Country | US
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Telephone | 614-476-8780
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Fax | 614-475-7006
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Provider Business Mailing Address
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Address Line | 7211 S EASTERN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89119-4574
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Country | US
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Telephone | 702-823-0086
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30-022946
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7274
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License Number State | NV
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