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General NPI Number Information
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NPI Number | 1922869338
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Entity Type | Organization
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Legal Business Name | GINA NICOLOSO DMD PLLC
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 6605 SE 221ST ST
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City | HAWTHORNE
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State | FL
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Zip | 32640-3815
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Country | US
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Telephone | 352-481-2741
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Fax | 352-481-5341
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Provider Business Mailing Address
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Address Line | 6605 SE 221ST ST
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City | HAWTHORNE
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State | FL
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Zip | 32640-3815
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Country | US
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Telephone | 352-481-2741
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Fax | 352-481-5341
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Authorized Official
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Title or Position | OWNER
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Name | GINA NICOLOSO
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Credential |
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Telephone | 850-509-9465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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