Provider Demographics
NPI:1487327771
Name:PEREZ ESTRADA, OLGA LUCIA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:LUCIA
Last Name:PEREZ ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SE LAKE WEIR AVE APT 1010
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6731
Mailing Address - Country:US
Mailing Address - Phone:952-688-9896
Mailing Address - Fax:
Practice Address - Street 1:1220 NE 36TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4931
Practice Address - Country:US
Practice Address - Phone:352-732-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27974124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist