Provider Demographics
NPI:1962692996
Name:DE OLIVEIRA, GISELE R (DMD)
Entity type:Individual
Prefix:DR
First Name:GISELE
Middle Name:R
Last Name:DE OLIVEIRA
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 1:987 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7048
Mailing Address - Country:US
Mailing Address - Phone:954-753-4005
Mailing Address - Fax:954-753-7191
Practice Address - Street 1:987 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7048
Practice Address - Country:US
Practice Address - Phone:954-753-4005
Practice Address - Fax:954-753-7191
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN174841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice