Olvera Dental

Primary specialty

DentistTaxonomy code 122300000X

License

2009024563 Issued in MO

Legal business name

OLVERA DENTAL

Practice address

1301 N Kingshighway Blvd
Saint Louis, MO 63113-1408

Phone

(314) 367-1434

Fax

(314) 367-2217

NPI assigned

Jan 18, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Melissa Selene Olvera, DDS

Title

General Dentist

Phone

(314) 367-1434

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326844800000",
    "number": "1083985345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 N KINGSHIGHWAY BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631131408",
            "telephone_number": "314-367-1434",
            "fax_number": "314-367-2217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 N KINGSHIGHWAY BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631131408",
            "telephone_number": "314-367-1434",
            "fax_number": "314-367-2217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLVERA DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-18",
        "last_updated": "2012-01-18",
        "status": "A",
        "authorized_official_last_name": "OLVERA",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "SELENE",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "314-367-1434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MO",
            "license": "2009024563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194957779",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Michael Olson, M.D.
• Tracy M Olson, PMHNP
• Olta Cuci
• Michael Olufawo, MD
• Franklin C Olumba, MD
• Olympic Rehab Wellness and Pain Center PC
• James Thomas Omalley
• Hasaan Omar
• Salma Khalid Omar, DO
• Ali Muayyad-Abdulla Omari, MD

• Dentist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.