Provider Demographics
NPI:1073700530
Name:OLIVEROS, MARIA RAYE GONZALES (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA RAYE
Middle Name:GONZALES
Last Name:OLIVEROS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2720
Mailing Address - Country:US
Mailing Address - Phone:310-830-5787
Mailing Address - Fax:310-830-3348
Practice Address - Street 1:625 E CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2720
Practice Address - Country:US
Practice Address - Phone:310-830-5787
Practice Address - Fax:310-830-3348
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist