Healthcare Provider Details

I. General information

NPI: 1558987404
Provider Name (Legal Business Name): RICARDO OBANDO DMD., MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11211 PROSPERITY FARMS RD STE B107
PALM BEACH GARDENS FL
33410-3453
US

IV. Provider business mailing address

11211 PROSPERITY FARMS RD STE B107
PALM BEACH GARDENS FL
33410-3453
US

V. Phone/Fax

Practice location:
  • Phone: 561-630-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN24966
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN24966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: