Provider Demographics
NPI:1083953855
Name:DENTAL BOOST LLC
Entity Type:Organization
Organization Name:DENTAL BOOST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABALDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-822-4607
Mailing Address - Street 1:344 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6719
Mailing Address - Country:US
Mailing Address - Phone:302-822-4607
Mailing Address - Fax:
Practice Address - Street 1:344 W 65TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6719
Practice Address - Country:US
Practice Address - Phone:302-822-4607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty