Provider Demographics
NPI:1386738086
Name:OLIVEIRA, JENNIFER K (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:K
Last Name:OLIVEIRA
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 1:2428 SANTA MONICA BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2047
Mailing Address - Country:US
Mailing Address - Phone:216-233-9272
Mailing Address - Fax:
Practice Address - Street 1:2428 SANTA MONICA BLVD STE 303
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2047
Practice Address - Country:US
Practice Address - Phone:216-233-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300224201223G0001X
OH30-0224201223G0001X
CA60132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice