Provider Demographics
NPI:1609206663
Name:JAMES R OLIVARI DMD PA
Entity Type:Organization
Organization Name:JAMES R OLIVARI DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-939-8181
Mailing Address - Street 1:163 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-2003
Mailing Address - Country:US
Mailing Address - Phone:201-939-8181
Mailing Address - Fax:201-939-2848
Practice Address - Street 1:163 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:WOOD RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-2003
Practice Address - Country:US
Practice Address - Phone:201-939-8181
Practice Address - Fax:201-939-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01513100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty