Healthcare Provider Details

I. General information

NPI: 1609492578
Provider Name (Legal Business Name): RUBEN GUSTAVO DABOIN AREVALO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1378 S NARCOOSSEE RD
SAINT CLOUD FL
34771-7251
US

IV. Provider business mailing address

13136 ALDERLEY DR
ORLANDO FL
32832-6342
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-0600
  • Fax: 407-979-4052
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN24970
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: