Healthcare Provider Details

I. General information

NPI: 1184557597
Provider Name (Legal Business Name): GINO AKIO APARICIO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 DEARBORN AVE NE
KEIZER OR
97303-4552
US

IV. Provider business mailing address

1726 PENNSYLVANIA AVE
AUGUSTA GA
30904-5369
US

V. Phone/Fax

Practice location:
  • Phone: 503-393-2696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12344
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: