Provider Demographics
NPI:1992244958
Name:OLIVA, ANA MARIA (DDS)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:OLIVA
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 1:15620 116TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-4624
Mailing Address - Country:US
Mailing Address - Phone:206-683-0056
Mailing Address - Fax:
Practice Address - Street 1:948 DIABLO AVE
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4025
Practice Address - Country:US
Practice Address - Phone:415-897-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist