Provider Demographics
NPI:1124135892
Name:MAHLER, GABRIELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:
Last Name:MAHLER
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 1:1925 S DURANGO AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1116
Mailing Address - Country:US
Mailing Address - Phone:201-349-8373
Mailing Address - Fax:
Practice Address - Street 1:1925 S DURANGO AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1116
Practice Address - Country:US
Practice Address - Phone:201-349-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO23229001223G0001X
NY052087-11223G0001X
CA59018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice