Provider Demographics
NPI:1386841690
Name:GHERBALI, ALEXANDRA DIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:DIANA
Last Name:GHERBALI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 NE 192ND ST APT 1003
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2458
Mailing Address - Country:US
Mailing Address - Phone:305-318-2622
Mailing Address - Fax:
Practice Address - Street 1:7415 MIAMI LAKES DRIVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-512-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17624122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist