Provider Demographics
NPI:1659937191
Name:QUINONES-BETANCOURT, GABRIEL ANTONIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:ANTONIO
Last Name:QUINONES-BETANCOURT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 NW 57TH AVE STE 344
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2042
Mailing Address - Country:US
Mailing Address - Phone:305-264-2711
Mailing Address - Fax:
Practice Address - Street 1:815 NW 57TH AVE STE 344
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2042
Practice Address - Country:US
Practice Address - Phone:305-264-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN241451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program