Gabrielle Erica Polyakov, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

109458 Issued in CA

Practice address

10505 W Pico Blvd
Los Angeles, CA 90064-2319

Phone

(310) 475-0617

NPI assigned

Jul 26, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dillon Costantino Dental Partnership

  • General Practice Dentistry
  • Los Angeles, CA
  • NPI 1750083887
  NPD
• Lindsay Costantino, DDS Inc

  • General Practice Dentistry
  • Los Angeles, CA
  • NPI 1578376323
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721952000000",
    "number": "1023846383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4215 PRADO DE LOS PAJAROS",
            "city": "CALABASAS",
            "state": "CA",
            "postal_code": "913023618",
            "telephone_number": "818-404-4229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10505 W PICO BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900642319",
            "telephone_number": "310-475-0617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLYAKOV",
        "first_name": "GABRIELLE",
        "middle_name": "ERICA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-26",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "109458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Doris Pollock, MD
• Jillian A. Polonchak, AGACNP-BC
• Douglas Polster, PHD
• David Allen Polstra, ACNPC-AG
• Daniel Lawrence Polyakov
• John Polykandriotis, MS, CGC
• Nadia Polynice, MFTI
• Jennifer Kay Polzin, PHARM.D
• Pom Pom'S Castle
• Pom Poms Castle

• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.