Provider Demographics
NPI:1265809107
Name:OLIVA PEREZ, ILIEG (DDS)
Entity type:Individual
Prefix:DR
First Name:ILIEG
Middle Name:
Last Name:OLIVA PEREZ
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 1:960 SW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4638
Mailing Address - Country:US
Mailing Address - Phone:305-202-4979
Mailing Address - Fax:
Practice Address - Street 1:2332 SW 82ND CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1247
Practice Address - Country:US
Practice Address - Phone:305-202-4979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 21522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist