Provider Demographics
NPI:1821251091
Name:OLIVER, ELANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELANA
Middle Name:
Last Name:OLIVER
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 1:4401 S ORANGE AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6968
Mailing Address - Country:US
Mailing Address - Phone:813-677-6113
Mailing Address - Fax:
Practice Address - Street 1:4401 S ORANGE AVE STE 106
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6968
Practice Address - Country:US
Practice Address - Phone:813-677-6113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN184171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice