Provider Demographics
NPI:1053147355
Name:VILELA SOUZA, NATHALIA
Entity type:Individual
Prefix:DR
First Name:NATHALIA
Middle Name:
Last Name:VILELA SOUZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 SW 16TH AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-8531
Mailing Address - Country:US
Mailing Address - Phone:352-682-9920
Mailing Address - Fax:
Practice Address - Street 1:1395 CENTER DRIVE
Practice Address - Street 2:ROOM D1-19
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0434
Practice Address - Country:US
Practice Address - Phone:352-273-7846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRPM28021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics