Provider Demographics
NPI:1952486458
Name:GUNDIAN, MARIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:GUNDIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12960 LERIDA ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33156-6424
Mailing Address - Country:US
Mailing Address - Phone:305-661-7681
Mailing Address - Fax:
Practice Address - Street 1:6705 S RED RD
Practice Address - Street 2:SUITE 308
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3622
Practice Address - Country:US
Practice Address - Phone:305-667-3673
Practice Address - Fax:305-667-2311
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN000116031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650392734OtherTIN