Provider Demographics
NPI:1316038359
Name:DE SIMONE, GIANNA MARIA (DMD)
Entity Type:Individual
Prefix:
First Name:GIANNA
Middle Name:MARIA
Last Name:DE SIMONE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 QUAILS RUN PASS
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-4143
Mailing Address - Country:US
Mailing Address - Phone:863-875-4798
Mailing Address - Fax:
Practice Address - Street 1:1550 1ST ST S
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4306
Practice Address - Country:US
Practice Address - Phone:863-293-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN165381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice