Provider Demographics
NPI:1073065306
Name:OLIVEIRA, ROGERIO
Entity Type:Individual
Prefix:
First Name:ROGERIO
Middle Name:
Last Name:OLIVEIRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROGERIO
Other - Middle Name:A
Other - Last Name:OLIVEIRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6 WILLOW BCH
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-5013
Mailing Address - Country:US
Mailing Address - Phone:973-715-3183
Mailing Address - Fax:
Practice Address - Street 1:6 WILLOW BCH
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-5013
Practice Address - Country:US
Practice Address - Phone:973-715-3183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0485041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist