Provider Demographics
NPI:1720547227
Name:BEKOV, GABRIELLE (DDS)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:BEKOV
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 1:211 189TH TER
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2311
Mailing Address - Country:US
Mailing Address - Phone:914-310-5014
Mailing Address - Fax:
Practice Address - Street 1:1600 E ATLANTIC BLVD FL 2
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6768
Practice Address - Country:US
Practice Address - Phone:914-310-5014
Practice Address - Fax:954-666-0493
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN262771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program