Provider Demographics
NPI:1174660575
Name:GIERBOLINI, JAIME RAFAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:RAFAEL
Last Name:GIERBOLINI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CALLE JOSE I QUINTON
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-2448
Mailing Address - Country:US
Mailing Address - Phone:787-825-1660
Mailing Address - Fax:787-825-1660
Practice Address - Street 1:49 CALLE JOSE I QUINTON
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-2448
Practice Address - Country:US
Practice Address - Phone:787-825-1660
Practice Address - Fax:787-825-1660
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice