Provider Demographics
NPI:1891040150
Name:BURGOS, GISELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GISELA
Middle Name:
Last Name:BURGOS
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 1:11061SW28TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2309
Mailing Address - Country:US
Mailing Address - Phone:305-965-4429
Mailing Address - Fax:
Practice Address - Street 1:3600 RED RD STE 604
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6016
Practice Address - Country:US
Practice Address - Phone:305-965-4429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN197641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice