Provider Demographics
NPI:1922214501
Name:OLAER, MARITONE SUANSING (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARITONE
Middle Name:SUANSING
Last Name:OLAER
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 1:547 E CALORA ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-2157
Mailing Address - Country:US
Mailing Address - Phone:626-339-8434
Mailing Address - Fax:
Practice Address - Street 1:1855 N FAIR OAKS AVE # G100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1620
Practice Address - Country:US
Practice Address - Phone:626-398-5970
Practice Address - Fax:626-398-6144
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55264OtherDENTAL LICENSE