Provider Demographics
NPI:1215323944
Name:INVERSO, GINO (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:GINO
Middle Name:
Last Name:INVERSO
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 MANTUA PIKE STE 302
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1249
Mailing Address - Country:US
Mailing Address - Phone:856-845-1341
Mailing Address - Fax:
Practice Address - Street 1:992 MANTUA PIKE STE 302
Practice Address - Street 2:
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1249
Practice Address - Country:US
Practice Address - Phone:856-845-1341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD474313204E00000X
NJ12153239441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery