Provider Demographics
NPI:1700015377
Name:GAMBOA, JANNET E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANNET
Middle Name:E
Last Name:GAMBOA
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 1:10775 NW 50TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3967
Mailing Address - Country:US
Mailing Address - Phone:305-331-8016
Mailing Address - Fax:
Practice Address - Street 1:10775 NW 50TH ST APT 208
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3967
Practice Address - Country:US
Practice Address - Phone:305-331-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-04
Last Update Date:2009-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN186221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice