Healthcare Provider Details

I. General information

NPI: 1194715458
Provider Name (Legal Business Name): ANGEL F OLIVERO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 CALLE CIELO
FAJARDO PR
00738-5127
US

IV. Provider business mailing address

PO BOX 1281
FAJARDO PR
00738-1281
US

V. Phone/Fax

Practice location:
  • Phone: 787-863-4918
  • Fax: 787-863-5997
Mailing address:
  • Phone: 787-863-4918
  • Fax: 787-863-5997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number824
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: