Provider Demographics
NPI:1093275414
Name:OLIVERIO, LAUREN HALEY
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:HALEY
Last Name:OLIVERIO
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 1:63 GARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1367
Mailing Address - Country:US
Mailing Address - Phone:304-677-2279
Mailing Address - Fax:
Practice Address - Street 1:5735 MEEKER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1180
Practice Address - Country:US
Practice Address - Phone:937-548-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417110122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist