Provider Demographics
NPI:1518088749
Name:NEIVA, GISELE DE FARIA (DDS)
Entity Type:Individual
Prefix:
First Name:GISELE
Middle Name:DE FARIA
Last Name:NEIVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:GISELE
Other - Middle Name:F
Other - Last Name:NEIVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1011 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1078
Mailing Address - Country:US
Mailing Address - Phone:734-647-7556
Mailing Address - Fax:734-936-1597
Practice Address - Street 1:1011 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1078
Practice Address - Country:US
Practice Address - Phone:734-647-7556
Practice Address - Fax:734-936-1597
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2952000320122300000X
MI29010181031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1443051OtherUNITED CONCORDIA
MID181030OtherBCBS OF MI DENTAL
MI1958163190OtherBCBS OF MI MED SURGICAL