Provider Demographics
NPI:1942319009
Name:OLIVA, ROGER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:OLIVA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MILLSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SHAMONG
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-8920
Mailing Address - Country:US
Mailing Address - Phone:609-268-2222
Mailing Address - Fax:609-268-8361
Practice Address - Street 1:1 MILLSTONE DR
Practice Address - Street 2:
Practice Address - City:SHAMONG
Practice Address - State:NJ
Practice Address - Zip Code:08088-8920
Practice Address - Country:US
Practice Address - Phone:609-268-2222
Practice Address - Fax:609-268-8361
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI017971001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice