Healthcare Provider Details

I. General information

NPI: 1942309836
Provider Name (Legal Business Name): MICHAEL JOEL GEBHART DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 SW 92 ST SUITE 203
MIAMI FL
33156-7379
US

IV. Provider business mailing address

8500 SW 92 ST SUITE 203
MIAMI FL
33156-7379
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-5321
  • Fax: 305-271-3708
Mailing address:
  • Phone: 305-271-5321
  • Fax: 305-271-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4584
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: