Provider Demographics
NPI:1295308211
Name:OLIVA-PEREZ DENTAL GROUP
Entity type:Organization
Organization Name:OLIVA-PEREZ DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILIEG
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVA PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-223-2828
Mailing Address - Street 1:13323 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3269
Mailing Address - Country:US
Mailing Address - Phone:305-223-2828
Mailing Address - Fax:305-223-1459
Practice Address - Street 1:13323 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3269
Practice Address - Country:US
Practice Address - Phone:305-223-2828
Practice Address - Fax:305-223-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty