Provider Demographics
NPI:1942649900
Name:LOPES DE OLIVEIRA, GUSTAVO (DMD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:
Last Name:LOPES DE OLIVEIRA
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 1:1407 BELMONT DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2402
Mailing Address - Country:US
Mailing Address - Phone:407-627-9111
Mailing Address - Fax:
Practice Address - Street 1:112 E LUCERNE CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-4401
Practice Address - Country:US
Practice Address - Phone:407-425-4901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-22
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ390200000X
FLDN20483332B00000X
FLDN 20483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies