Provider Demographics
NPI:1013096221
Name:TAMAYO, OLIVA RIA FLORES (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLIVA RIA
Middle Name:FLORES
Last Name:TAMAYO
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 1:725 N CENTRAL AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1658
Mailing Address - Country:US
Mailing Address - Phone:623-925-8208
Mailing Address - Fax:623-925-8108
Practice Address - Street 1:725 N CENTRAL AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1658
Practice Address - Country:US
Practice Address - Phone:623-925-8208
Practice Address - Fax:623-925-8108
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD55021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice