Provider Demographics
NPI:1730357716
Name:MAAL, ROBERTO (DDS)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:MAAL
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 1:35 NEWPORT ST
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-6556
Mailing Address - Country:US
Mailing Address - Phone:850-478-9930
Mailing Address - Fax:850-478-9950
Practice Address - Street 1:35 NEWPORT ST
Practice Address - Street 2:NONE
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-6556
Practice Address - Country:US
Practice Address - Phone:850-478-9930
Practice Address - Fax:850-478-9950
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-001353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist