Provider Demographics
NPI:1598969149
Name:OLIVARES, SONIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:
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 1:8353 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6615
Mailing Address - Country:US
Mailing Address - Phone:305-620-8272
Mailing Address - Fax:786-513-3244
Practice Address - Street 1:8353 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6615
Practice Address - Country:US
Practice Address - Phone:305-620-8272
Practice Address - Fax:786-513-3244
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN114961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL463035470OtherTAX ID
FL464278917OtherTIN