Provider Demographics
NPI:1699980961
Name:ANA M GAMA DDS, INC
Entity type:Organization
Organization Name:ANA M GAMA DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAMA
Authorized Official - Suffix:
Authorized Official - Credentials:GENERAL DENTIST
Authorized Official - Phone:909-986-1003
Mailing Address - Street 1:1270 W FOOTHILL BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4688
Mailing Address - Country:US
Mailing Address - Phone:909-986-1003
Mailing Address - Fax:
Practice Address - Street 1:1170 W FOOTHILL BLVD
Practice Address - Street 2:STE D
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4685
Practice Address - Country:US
Practice Address - Phone:909-986-1003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty