Provider Demographics
NPI:1790007730
Name:DR. OLIVER & ASOCIADOS DENTISTAS
Entity Type:Organization
Organization Name:DR. OLIVER & ASOCIADOS DENTISTAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-380-5157
Mailing Address - Street 1:600 BOULEVARD 393
Mailing Address - Street 2:ARBOLES DE MONTEHIEDRA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-380-5157
Mailing Address - Fax:
Practice Address - Street 1:600 BOULEVARD DE LOS ARBOLES #393
Practice Address - Street 2:ARBOLES DE MONTEHIEDRA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-380-5157
Practice Address - Fax:787-731-4268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR55071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty