Provider Demographics
NPI:1386321271
Name:MARZIALE, OLIVIA GRACE (DDS)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:GRACE
Last Name:MARZIALE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-9793
Mailing Address - Country:US
Mailing Address - Phone:315-383-5056
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DRIE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0001
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program