Provider Demographics
NPI:1568528347
Name:OLIVAREZ, MIGUEL T (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:T
Last Name:OLIVAREZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6240
Mailing Address - Country:US
Mailing Address - Phone:928-782-4707
Mailing Address - Fax:928-782-2212
Practice Address - Street 1:2179 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6240
Practice Address - Country:US
Practice Address - Phone:928-782-4707
Practice Address - Fax:928-782-2212
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ57961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice