MEDICARE: ADRIANA GABALDON II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	DN18595	FL

General Provider Information

NPI Number	:	1699121574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADRIANA GABALDON II

Provider Business Mailing Address
First Line	:	3877 TAMIAMI TRL E UNIT 140
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-6230
Country	:	US
Telephone Number	:	239-287-6894
Fax Number	:

Provider Business Practice Location Address
First Line	:	3877 TAMIAMI TRL E UNIT 140
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-6230
Country	:	US
Telephone Number	:	239-287-6894
Fax Number	:

Authorized Official
Title or Position	:	OWNER / GENERAL DENTIST
Name	:	DR. ADRIANA GABALDON
Credential	:	DDS
Telephone Number	:	239-455-1018

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	05/10/2016

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