Provider Demographics
NPI:1861709412
Name:KRISHNAN, GAIL ANN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:ANN
Last Name:KRISHNAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W CENTRAL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3373
Mailing Address - Country:US
Mailing Address - Phone:714-990-0204
Mailing Address - Fax:
Practice Address - Street 1:255 W CENTRAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3373
Practice Address - Country:US
Practice Address - Phone:714-990-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010201741223G0001X
CADDS652621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice