Provider Demographics
NPI:1124233648
Name:NIETO, GLORIA YALILE (DMD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:YALILE
Last Name:NIETO
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 1:5937 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3245
Mailing Address - Country:US
Mailing Address - Phone:954-589-0750
Mailing Address - Fax:954-639-7143
Practice Address - Street 1:5937 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3245
Practice Address - Country:US
Practice Address - Phone:954-589-0750
Practice Address - Fax:954-639-7143
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16408122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist