Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN19630 | FL |
NPI | 1063994333 |
---|---|
Provider Name | Regina Gelman-Bercovich |
First Address | Hollywood, FL 33019-5023 |
Second Address | Doral, FL 33178-3375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2018 |
Last Update Date | 04/09/2018 |