Provider Demographics
NPI:1073046603
Name:GANDARA HIDALGO, MARIA TERESA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:TERESA
Last Name:GANDARA HIDALGO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13728 SW 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4000
Mailing Address - Country:US
Mailing Address - Phone:305-456-7383
Mailing Address - Fax:305-676-9028
Practice Address - Street 1:13728 SW 84TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4000
Practice Address - Country:US
Practice Address - Phone:305-456-7383
Practice Address - Fax:305-676-9028
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN244941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice