Provider Demographics
NPI:1831753052
Name:DOUGLAS, FABIOLA MARIA (DDS)
Entity type:Individual
Prefix:
First Name:FABIOLA
Middle Name:MARIA
Last Name:DOUGLAS
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 1:909 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5029
Mailing Address - Country:US
Mailing Address - Phone:407-933-0885
Mailing Address - Fax:407-933-0520
Practice Address - Street 1:909 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5029
Practice Address - Country:US
Practice Address - Phone:407-933-0885
Practice Address - Fax:407-933-0520
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN257771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty