Basic Information
| Provider Information | |||||||||
| NPI: | 1780989053 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | G'S DENTAL STUDIO, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12920 W PARMER LN STE 101 | ||||||||
| Address2: | |||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786137635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124107774 | ||||||||
| FaxNumber: | 8665117471 | ||||||||
| Practice Location | |||||||||
| Address1: | 12920 W PARMER LN STE 101 | ||||||||
| Address2: | |||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786137635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124107774 | ||||||||
| FaxNumber: | 8665117471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2011 | ||||||||
| LastUpdateDate: | 01/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | KIPROVSKA-GAVRILOVA | ||||||||
| AuthorizedOfficialFirstName: | HRISTINA | ||||||||
| AuthorizedOfficialMiddleName: | TODOROVA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5614524923 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 24310 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.