Individual
GABRIEL BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(757) 953-5000
Mailing address
1140 LONDON BLVD APT 2109, PORTSMOUTH, VA 23704-0004
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14234167
UT
Other
Enumeration date
09/02/2025
Last updated
09/02/2025
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