Provider Demographics
NPI:1760832083
Name:OLIVERO, ELBA GRACIELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELBA
Middle Name:GRACIELA
Last Name:OLIVERO
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 1:100 DEEP GAP RUN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5832
Mailing Address - Country:US
Mailing Address - Phone:919-608-9197
Mailing Address - Fax:
Practice Address - Street 1:507 S CHERRY GROVE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4244
Practice Address - Country:US
Practice Address - Phone:410-990-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist