MEDICARE: DR. JACLYN GAMBERINI HARDEN DMD

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	122300000X	Dentist	DS037528	PA
2	122300000X	Dentist	DN18601	FL

General Provider Information

NPI Number	:	1619130572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACLYN GAMBERINI HARDEN DMD

Provider Business Mailing Address
First Line	:	941 FIRETREE RD
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-4007
Country	:	US
Telephone Number	:	561-401-2501
Fax Number	:

Provider Business Practice Location Address
First Line	:	941 FIRETREE RD
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-4007
Country	:	US
Telephone Number	:	561-401-2501
Fax Number	:

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

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	01/03/2012

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