Healthcare Provider Details

I. General information

NPI: 1114816261
Provider Name (Legal Business Name): SAIDE OLVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12450 SW WALKER RD
BEAVERTON OR
97005-1401
US

IV. Provider business mailing address

12450 SW WALKER RD
BEAVERTON OR
97005-1401
US

V. Phone/Fax

Practice location:
  • Phone: 971-201-5210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: