Provider Demographics
NPI:1992204531
Name:JANNET E GAMBOA DDS INC
Entity Type:Organization
Organization Name:JANNET E GAMBOA DDS INC
Other - Org Name:GAMBOA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANNET
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:GAMBOA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-477-7601
Mailing Address - Street 1:10818 NW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2854
Mailing Address - Country:US
Mailing Address - Phone:305-477-7601
Mailing Address - Fax:305-471-0137
Practice Address - Street 1:10818 NW 58TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2854
Practice Address - Country:US
Practice Address - Phone:305-477-7601
Practice Address - Fax:305-471-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty