Provider Demographics
NPI:1275873119
Name:OLIVEIRA, DANIEL DIAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DIAS
Last Name:OLIVEIRA
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 1:1107 GRAND AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-6054
Mailing Address - Country:US
Mailing Address - Phone:443-610-2252
Mailing Address - Fax:
Practice Address - Street 1:1907 ROUTE 35
Practice Address - Street 2:SUITE 4
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2765
Practice Address - Country:US
Practice Address - Phone:732-531-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02513100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist