Provider Demographics
NPI:1841576790
Name:OLVERA, BRIAN JESSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JESSE
Last Name:OLVERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6444 YORK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3642
Mailing Address - Country:US
Mailing Address - Phone:323-351-4922
Mailing Address - Fax:
Practice Address - Street 1:6444 YORK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-3642
Practice Address - Country:US
Practice Address - Phone:323-351-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist