Provider Demographics
NPI:1447904826
Name:GABRIELLE L WEISHOFF DMD LLC
Entity type:Organization
Organization Name:GABRIELLE L WEISHOFF DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEISHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-939-7993
Mailing Address - Street 1:901 DALE CT
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-8915
Mailing Address - Country:US
Mailing Address - Phone:503-939-7993
Mailing Address - Fax:
Practice Address - Street 1:310 E CHARLES ST
Practice Address - Street 2:
Practice Address - City:MOUNT ANGEL
Practice Address - State:OR
Practice Address - Zip Code:97362-9657
Practice Address - Country:US
Practice Address - Phone:503-845-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental