| Organization Name: | OLIVERIE DENTAL LLC |
| NPI Number: | 1407179237 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY OLIVERIE (OWNER) |
| Mailing Address: | 1516 Hwy 138 Suite 1a Wall |
| State: | NJ US |
| Postal Code: | 077193700 |
| Phone Number: | 7326815544 |
| Fax Number: | |
| NPI Enumeration Date: | 03/08/2010 |
| NPI Last Update Date: | 03/08/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DI20496 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |