Provider Demographics
NPI:1568137990
Name:OLIVARES, KAREN EDITH (DDS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:EDITH
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 1:1719 KINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8301
Mailing Address - Country:US
Mailing Address - Phone:956-764-0520
Mailing Address - Fax:
Practice Address - Street 1:20172 US HIGHWAY 59 STE B
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-5084
Practice Address - Country:US
Practice Address - Phone:832-604-3518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist