Active NPI
Paul Olivera III, D.D.S.
- General Practice Dentistry
- Claremont, CA
National Provider Identifier
1972654812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 31112
- Practice address
- 450 W San Jose Ave
Claremont, CA 91711-5404 - Phone
- (909) 626-1292
- Fax
- (909) 626-8193
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 31112 | CA | Primary |
Addresses
Primary practice location
450 W San Jose Ave
Claremont, CA 91711-5404
Mailing address
450 W San Jose Ave
Claremont, CA 91711-5404
Phone (909) 626-1292
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B3111201 | Other | CA | MEDI-CAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31112 | CA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972654812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 W SAN JOSE AVE",
"city": "CLAREMONT",
"state": "CA",
"postal_code": "917115404",
"telephone_number": "909-626-1292",
"fax_number": "909-626-8193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 W SAN JOSE AVE",
"city": "CLAREMONT",
"state": "CA",
"postal_code": "917115404",
"telephone_number": "909-626-1292",
"fax_number": "909-626-8193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVERA",
"first_name": "PAUL",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "31112",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL",
"identifier": "B3111201",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Claremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.