Provider Demographics
NPI:1043438971
Name:GAPUZ,JR., ALFREDO MALLARE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:MALLARE
Last Name:GAPUZ,JR.
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:AESTHETIC AND
Other - Middle Name:GENERAL
Other - Last Name:DENTISTRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:14009 EGRET TOWER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6197
Mailing Address - Country:US
Mailing Address - Phone:407-251-5100
Mailing Address - Fax:407-251-4397
Practice Address - Street 1:14009 EGRET TOWER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6197
Practice Address - Country:US
Practice Address - Phone:407-251-5100
Practice Address - Fax:407-251-4397
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN130681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice