Provider Demographics
NPI:1215047469
Name:GULBRANSEN, HAROLD J (DDS)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:J
Last Name:GULBRANSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8860 CENTER DR
Mailing Address - Street 2:SUITE #460
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3068
Mailing Address - Country:US
Mailing Address - Phone:619-463-3773
Mailing Address - Fax:619-463-1272
Practice Address - Street 1:8860 CENTER DR
Practice Address - Street 2:SUITE #460
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3068
Practice Address - Country:US
Practice Address - Phone:619-463-3773
Practice Address - Fax:619-463-1272
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292871223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB29287-01Medicaid
CAB29287-01Medicaid
CAT70455Medicare UPIN