Provider Demographics
NPI:1689238222
Name:GARIBALDI BERNUIL, EARVIN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:EARVIN
Middle Name:E
Last Name:GARIBALDI BERNUIL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N LOIS AVE UNIT 326
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2413
Mailing Address - Country:US
Mailing Address - Phone:813-317-0452
Mailing Address - Fax:
Practice Address - Street 1:625 N DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1099
Practice Address - Country:US
Practice Address - Phone:302-315-2019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25259122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist