Provider Demographics
NPI:1538360417
Name:GABALDON, ADRIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:
Last Name:GABALDON
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 1:21571 BELLA TERRA BLVD
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-7345
Mailing Address - Country:US
Mailing Address - Phone:305-764-9321
Mailing Address - Fax:
Practice Address - Street 1:3600 BROADWAY STE A
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8002
Practice Address - Country:US
Practice Address - Phone:239-344-2335
Practice Address - Fax:239-936-6228
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRP 4961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001370500Medicaid