Provider Demographics
NPI:1619031515
Name:OLIVERAS NEGRON, ELBA I (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELBA
Middle Name:I
Last Name:OLIVERAS NEGRON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21375
Mailing Address - Street 2:
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1375
Mailing Address - Country:US
Mailing Address - Phone:787-751-2112
Mailing Address - Fax:787-777-8146
Practice Address - Street 1:1055 CALLE BRUMBAUGH
Practice Address - Street 2:2DO PISO
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-2932
Practice Address - Country:US
Practice Address - Phone:787-751-2112
Practice Address - Fax:787-777-8146
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001238122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist