Provider Demographics
NPI:1770458424
Name:MALDONADO DUBON, THANIA FABIOLA (CRDH)
Entity type:Individual
Prefix:
First Name:THANIA
Middle Name:FABIOLA
Last Name:MALDONADO DUBON
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976-2505
Mailing Address - Country:US
Mailing Address - Phone:239-544-7476
Mailing Address - Fax:
Practice Address - Street 1:3415 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1576
Practice Address - Country:US
Practice Address - Phone:239-344-2385
Practice Address - Fax:239-368-0288
Is Sole Proprietor?:No
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH33197124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist