Provider Demographics
NPI:1548749732
Name:GABALDON, MICHAELA COREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:COREN
Last Name:GABALDON
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 1:4085 PLANT DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-7064
Mailing Address - Country:US
Mailing Address - Phone:505-903-8646
Mailing Address - Fax:
Practice Address - Street 1:1514 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-1105
Practice Address - Country:US
Practice Address - Phone:505-257-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist