Provider Demographics
NPI:1306613203
Name:ROBERTS, GABRIELLE INGRAM (DDS)
Entity type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:INGRAM
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GABRIELLE
Other - Middle Name:LEE
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:300 LAKE MARINA AVE APT 9BE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1678
Mailing Address - Country:US
Mailing Address - Phone:318-228-9941
Mailing Address - Fax:
Practice Address - Street 1:1100 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2715
Practice Address - Country:US
Practice Address - Phone:504-619-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7375122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist