Provider Demographics
NPI:1609492578
Name:DABOIN AREVALO, RUBEN GUSTAVO (DDS)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:GUSTAVO
Last Name:DABOIN AREVALO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13136 ALDERLEY DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1378 S NARCOOSSEE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-7251
Practice Address - Country:US
Practice Address - Phone:407-593-0600
Practice Address - Fax:407-979-4052
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN249701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice