Healthcare Provider Details

I. General information

NPI: 1144089202
Provider Name (Legal Business Name): DAVIARLYS GILBERTO DAVID THEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4765 W ATLANTIC AVE
DELRAY BEACH FL
33445-3838
US

IV. Provider business mailing address

750 E 25TH ST
HIALEAH FL
33013-3817
US

V. Phone/Fax

Practice location:
  • Phone: 305-694-5400
  • Fax:
Mailing address:
  • Phone: 305-694-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: