Provider Demographics
NPI:1275663734
Name:OLIVARES, MARIANELA ELEIDA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIANELA
Middle Name:ELEIDA
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PANORAMA TRL
Mailing Address - Street 2:BUILDING 1, SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2404
Mailing Address - Country:US
Mailing Address - Phone:585-586-8600
Mailing Address - Fax:585-586-2686
Practice Address - Street 1:625 PANORAMA TRL
Practice Address - Street 2:BUILDING 1, SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2404
Practice Address - Country:US
Practice Address - Phone:585-586-8600
Practice Address - Fax:585-586-2686
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist