Basic Information
| Provider Information | |||||||||
| NPI: | 1336759653 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GURION | ||||||||
| FirstName: | GRETCHEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 E KATELLA AVE UNIT 3132 | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928056693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153689731 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5731 E SANTA ANA CANYON RD STE A | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928073234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149982956 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2020 | ||||||||
| LastUpdateDate: | 08/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DDS104100 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.