Provider Demographics
NPI:1225584907
Name:AQUINO, GREGORIO JOSEPH CRIS GUGOL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORIO JOSEPH CRIS
Middle Name:GUGOL
Last Name:AQUINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 SW ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5100
Mailing Address - Country:US
Mailing Address - Phone:772-224-1688
Mailing Address - Fax:
Practice Address - Street 1:3415 SW ELLIS ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5100
Practice Address - Country:US
Practice Address - Phone:772-224-1688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist