Provider Demographics
NPI:1861640625
Name:WILSON, GABRIELA TATARU (DMD)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:TATARU
Last Name:WILSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4574
Mailing Address - Country:US
Mailing Address - Phone:702-823-0086
Mailing Address - Fax:
Practice Address - Street 1:3727 EASTON MARKET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6023
Practice Address - Country:US
Practice Address - Phone:614-476-8780
Practice Address - Fax:614-475-7006
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0229461223G0001X
NV72741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice