Provider Demographics
NPI:1316442734
Name:PINO OLIVA, GISELLE (DDS)
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:PINO OLIVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SW 107TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3602
Mailing Address - Country:US
Mailing Address - Phone:305-551-6866
Mailing Address - Fax:786-605-5566
Practice Address - Street 1:300 SW 107TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3602
Practice Address - Country:US
Practice Address - Phone:305-551-6866
Practice Address - Fax:786-605-5566
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN254641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice