MEDICARE: DR. MARTA L GAINZA DMD FAGD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN 14406	FL

General Provider Information

NPI Number	:	1306040811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTA L GAINZA DMD FAGD

Provider Business Mailing Address
First Line	:	13314 SW 60TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-5104
Country	:	US
Telephone Number	:	305-374-0996
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 SW 10TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33130-4119
Country	:	US
Telephone Number	:	305-374-0996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	07/08/2007

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