Provider Demographics
NPI:1548403579
Name:MOGOLLON, MARIA GABRIELA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:GABRIELA
Last Name:MOGOLLON
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 1:15659 SW 88TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1103
Mailing Address - Country:US
Mailing Address - Phone:786-597-1636
Mailing Address - Fax:
Practice Address - Street 1:15659 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1103
Practice Address - Country:US
Practice Address - Phone:786-597-1636
Practice Address - Fax:786-338-7428
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist