Provider Demographics
NPI:1356553937
Name:PARAJON, GUSTAVO (DDS)
Entity type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:
Last Name:PARAJON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4238 US HIGHWAY 98 N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-3819
Mailing Address - Country:US
Mailing Address - Phone:863-815-8559
Mailing Address - Fax:863-815-1454
Practice Address - Street 1:4238 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3819
Practice Address - Country:US
Practice Address - Phone:863-815-8559
Practice Address - Fax:863-815-1454
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist