Provider Demographics
NPI:1124482682
Name:AQUINO, GABRIELLE CRUZ (DMD)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:CRUZ
Last Name:AQUINO
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 1:8370 W CHEYENNE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-2174
Mailing Address - Country:US
Mailing Address - Phone:702-843-5141
Mailing Address - Fax:
Practice Address - Street 1:8710 W CHARLESTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5467
Practice Address - Country:US
Practice Address - Phone:702-330-8952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-2111223P0221X
PADS042133122300000X
NV6760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05408282Medicaid