=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043887110
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GABRIELLA RENEE HUROV DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2021
-----------------------------------------------------
Last Update Date | 06/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5380 DONALD ROSS RD STE 100
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33418-7282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-943-8832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10240 COTTONWOOD CREEK BLVD
-----------------------------------------------------
City | BLAIR
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68008-6635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-943-8832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 25840
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------