Provider Demographics
NPI:1588820989
Name:DENTAL PARTNERS OF GABLES
Entity Type:Organization
Organization Name:DENTAL PARTNERS OF GABLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:COULTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-331-7055
Mailing Address - Street 1:5511 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2272
Mailing Address - Country:US
Mailing Address - Phone:786-331-7055
Mailing Address - Fax:
Practice Address - Street 1:5511 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2272
Practice Address - Country:US
Practice Address - Phone:786-331-7055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16954302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization