Provider Demographics
NPI:1851638019
Name:GABLES EXCEPTIONAL DENTISTRY LLC
Entity Type:Organization
Organization Name:GABLES EXCEPTIONAL DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-569-9001
Mailing Address - Street 1:357 ALMERIA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5801
Mailing Address - Country:US
Mailing Address - Phone:305-569-9001
Mailing Address - Fax:
Practice Address - Street 1:357 ALMERIA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5801
Practice Address - Country:US
Practice Address - Phone:305-569-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty