Provider Demographics
NPI:1629296173
Name:DUARTE, FABIOLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:FABIOLA
Middle Name:
Last Name:DUARTE
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 1:300 NW 70TH AVE
Mailing Address - Street 2:SUITE #104
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2384
Mailing Address - Country:US
Mailing Address - Phone:954-327-8075
Mailing Address - Fax:954-327-8015
Practice Address - Street 1:300 NW 70TH AVE
Practice Address - Street 2:SUITE #104
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2384
Practice Address - Country:US
Practice Address - Phone:954-327-8075
Practice Address - Fax:954-327-8015
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15644122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist