Healthcare Provider Details

I. General information

NPI: 1972033751
Provider Name (Legal Business Name): MICHAEL AGUIRRE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD # D7-6
GAINESVILLE FL
32610-2609
US

IV. Provider business mailing address

1600 SW ARCHER RD # D7-6
GAINESVILLE FL
32610-0416
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6750
  • Fax:
Mailing address:
  • Phone: 352-273-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDN22586
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN22586
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN22586
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN22586
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: