MEDICARE: DR. GABRIELLE MAHLER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DIO2322900	NJ
2	1223G0001X	General Practice Dentistry	052087-1	NY
3	122300000X	Dentist	59018	CA

General Provider Information

NPI Number	:	1124135892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIELLE MAHLER DMD

Provider Business Mailing Address
First Line	:	1925 S DURANGO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-1116
Country	:	US
Telephone Number	:	201-349-8373
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 S DURANGO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-1116
Country	:	US
Telephone Number	:	201-349-8373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	01/04/2016

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