Provider Demographics
NPI:1518482363
Name:GAETA, ALEXANDRE EIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRE
Middle Name:EIAN
Last Name:GAETA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 GLENCOE AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-3801
Mailing Address - Country:US
Mailing Address - Phone:626-264-0182
Mailing Address - Fax:
Practice Address - Street 1:3951 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-4900
Practice Address - Country:US
Practice Address - Phone:772-888-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-12
Last Update Date:2017-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN229881223G0001X
CA1018261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice