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General NPI Number Information
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NPI Number | 1194953950
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Entity Type | Organization
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Legal Business Name | GABLES FAMILY DENTAL, INC.
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 2990 CORAL WAY
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City | CORAL GABLES
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State | FL
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Zip | 33145-3206
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Country | US
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Telephone | 305-529-9295
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Fax | 305-529-2551
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Provider Business Mailing Address
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Address Line | 2990 CORAL WAY
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City | CORAL GABLES
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State | FL
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Zip | 33145-3206
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Country | US
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Telephone | 305-529-9295
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Fax | 305-529-2551
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELIAS TOBON
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Credential | D.M.D.
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Telephone | 305-529-9295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN14672
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License Number State | FL
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