Provider Demographics
NPI:1013460658
Name:OLIVIERI, PETRA
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:
Last Name:OLIVIERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-6200
Mailing Address - Fax:513-245-3672
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-475-8783
Practice Address - Fax:513-475-7698
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2024-06-17
Deactivation Date:2017-03-13
Deactivation Code:
Reactivation Date:2017-04-11
Provider Licenses
StateLicense IDTaxonomies
OH30.0263581223S0112X
OH35.141381204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery