Provider Demographics
NPI:1134357577
Name:OLIVA, JOSIE GEMARIE DE LEON (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSIE
Middle Name:GEMARIE DE LEON
Last Name:OLIVA
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 1:4143 E DEVON DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1411
Mailing Address - Country:US
Mailing Address - Phone:224-610-9823
Mailing Address - Fax:
Practice Address - Street 1:3125 W HUNT HWY STE 101
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85142-9331
Practice Address - Country:US
Practice Address - Phone:480-900-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0279251223G0001X
AZD0101371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice