=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558162156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GABLES PERFECT SMILE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2025
-----------------------------------------------------
Last Update Date | 03/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1805 PONCE DE LEON BLVD STE 401
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-4455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-443-8225
-----------------------------------------------------
Fax | 305-443-8316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1805 PONCE DE LEON BLVD STE 401
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-4455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-443-8225
-----------------------------------------------------
Fax | 305-443-8316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SANDRINE RIBOUL
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 305-443-8225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------