Provider Demographics
NPI:1427131333
Name:OLIVERI, ANTHONY JOHN (DDS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:OLIVERI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2621
Mailing Address - Country:US
Mailing Address - Phone:631-928-3644
Mailing Address - Fax:631-331-3144
Practice Address - Street 1:43 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2621
Practice Address - Country:US
Practice Address - Phone:631-928-3644
Practice Address - Fax:631-331-3144
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0289741223G0001X
AZD69291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice