Provider Demographics
NPI:1669850103
Name:DRPAULOLIVERA
Entity Type:Organization
Organization Name:DRPAULOLIVERA
Other - Org Name:DRPAULOLIVERA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVERA
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-626-1292
Mailing Address - Street 1:450WSANJOSE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711
Mailing Address - Country:US
Mailing Address - Phone:909-626-1292
Mailing Address - Fax:909-626-8193
Practice Address - Street 1:450WSANJOSE
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711
Practice Address - Country:US
Practice Address - Phone:909-626-1292
Practice Address - Fax:909-626-8193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty