Provider Demographics
NPI:1366608978
Name:GABUTEN, JAIME GALANO (DDS)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:GALANO
Last Name:GABUTEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAIME
Other - Middle Name:VALENTINO
Other - Last Name:GABUTEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4917 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2655
Mailing Address - Country:US
Mailing Address - Phone:714-826-4250
Mailing Address - Fax:714-826-4083
Practice Address - Street 1:4917 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2655
Practice Address - Country:US
Practice Address - Phone:714-826-4250
Practice Address - Fax:714-826-4083
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice