Individual
GUSTAVO VICENTIS DE OLIVEIRA FERNANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, DMD
Contact information
Practice address
1011 N UNIVERSITY AVE, ANN ARBOR, MI 48109-1078
(734) 736-2105
Mailing address
2785 WINDWOOD DR APT 175, ANN ARBOR, MI 48105-3401
(734) 510-2256
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2952000779
MI
Other
Enumeration date
12/07/2021
Last updated
12/07/2021
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