Provider Demographics
NPI:1194214080
Name:ALBERTALLI-WENSON, OLIVER M
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:M
Last Name:ALBERTALLI-WENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 SLIKER RD
Mailing Address - Street 2:
Mailing Address - City:GLEN GARDNER
Mailing Address - State:NJ
Mailing Address - Zip Code:08826-3046
Mailing Address - Country:US
Mailing Address - Phone:908-832-9164
Mailing Address - Fax:
Practice Address - Street 1:6428 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2910
Practice Address - Country:US
Practice Address - Phone:202-723-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10019931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice