Provider Demographics
NPI:1144282963
Name:GAMBOA, CRISTINA B (DDS)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:B
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E GLENOAKS BLVD
Mailing Address - Street 2:102
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-2036
Mailing Address - Country:US
Mailing Address - Phone:818-247-2611
Mailing Address - Fax:818-247-4387
Practice Address - Street 1:125 E GLENOAKS BLVD
Practice Address - Street 2:102
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-2036
Practice Address - Country:US
Practice Address - Phone:818-247-2611
Practice Address - Fax:818-247-4387
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice