Provider Demographics
NPI:1912603598
Name:KENDALL SQUARE DENTAL STUDIO PLLC
Entity Type:Organization
Organization Name:KENDALL SQUARE DENTAL STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANS
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDUL CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-354-1599
Mailing Address - Street 1:1142 SW 144TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-3252
Mailing Address - Country:US
Mailing Address - Phone:786-354-1599
Mailing Address - Fax:
Practice Address - Street 1:8905 SW 169TH CT STE 109
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-4770
Practice Address - Country:US
Practice Address - Phone:786-354-1599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental