Provider Demographics
NPI:1639350606
Name:GABLES DENTAL CARE
Entity Type:Organization
Organization Name:GABLES DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VACHARAKIAT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-443-7501
Mailing Address - Street 1:3815 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3001
Mailing Address - Country:US
Mailing Address - Phone:305-443-7501
Mailing Address - Fax:
Practice Address - Street 1:3815 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3001
Practice Address - Country:US
Practice Address - Phone:305-443-7501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty