MEDICARE: GABRIELA TATARU WILSON 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	30-022946	OH
2	1223G0001X	General Practice Dentistry	7274	NV

General Provider Information

NPI Number	:	1861640625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA TATARU WILSON DMD

Provider Business Mailing Address
First Line	:	7211 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4574
Country	:	US
Telephone Number	:	702-823-0086
Fax Number	:

Provider Business Practice Location Address
First Line	:	3727 EASTON MARKET
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-6023
Country	:	US
Telephone Number	:	614-476-8780
Fax Number	:	614-475-7006

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

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	01/12/2021

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