Healthcare Provider Details

I. General information

NPI: 1215515085
Provider Name (Legal Business Name): DR GUSTAVO DE OLIVEIRA DMD, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E LUCERNE CIR
ORLANDO FL
32801-4401
US

IV. Provider business mailing address

1407 BELMONT DR
ORLANDO FL
32806-2402
US

V. Phone/Fax

Practice location:
  • Phone: 407-425-4901
  • Fax:
Mailing address:
  • Phone: 407-627-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. GUSTAVO DE OLIVEIRA
Title or Position: OWNER
Credential: DMD
Phone: 407-425-4901