Provider Demographics
NPI:1922554708
Name:OLIVERLLAVONA LLC
Entity Type:Organization
Organization Name:OLIVERLLAVONA LLC
Other - Org Name:DENTAL SPECIALISTS OF WESTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-349-4993
Mailing Address - Street 1:2575 GLADES CIR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-2254
Mailing Address - Country:US
Mailing Address - Phone:954-349-4993
Mailing Address - Fax:954-349-4808
Practice Address - Street 1:2575 GLADES CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-2254
Practice Address - Country:US
Practice Address - Phone:954-349-4993
Practice Address - Fax:954-349-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN174691223E0200X
FLDN174401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty