Provider Demographics
NPI:1023742079
Name:DE LA PROVIDENCIA GASCON, MILENA IOME (DMD)
Entity type:Individual
Prefix:DR
First Name:MILENA
Middle Name:IOME
Last Name:DE LA PROVIDENCIA GASCON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 85TH ST APT 7
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4813
Mailing Address - Country:US
Mailing Address - Phone:305-951-2927
Mailing Address - Fax:
Practice Address - Street 1:701 N FEDERAL HWY STE 210
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2451
Practice Address - Country:US
Practice Address - Phone:305-951-2927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL273231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice