Provider Demographics
NPI:1962912915
Name:DIZON, GABRIELLE (DDS)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:DIZON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:
Other - Last Name:DIZON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:8080 N CENTRAL EXPY STE 1220
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1897
Mailing Address - Country:US
Mailing Address - Phone:214-801-3596
Mailing Address - Fax:
Practice Address - Street 1:8080 N CENTRAL EXPY STE 1220
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1897
Practice Address - Country:US
Practice Address - Phone:214-646-6202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$OtherPPO