Provider Demographics
NPI:1104543834
Name:GULATI, JENNIFER (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:GULATI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-1706
Mailing Address - Country:US
Mailing Address - Phone:404-702-6182
Mailing Address - Fax:
Practice Address - Street 1:500 SPRUCE ST RM 203
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2648
Practice Address - Country:US
Practice Address - Phone:415-752-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist