Organization
OLVERA DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELISSA SELENE OLVERA DDS (GENERAL DENTIST)
(314) 367-1434
Entity
Organization
Contact information
Practice address
1301 N KINGSHIGHWAY BLVD, SAINT LOUIS, MO 63113-1408
(314) 367-1434
(314) 367-2217
Mailing address
1301 N KINGSHIGHWAY BLVD, SAINT LOUIS, MO 63113-1408
(314) 367-1434
(314) 367-2217
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2009024563
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194957779
—
MO
Enumeration date
01/18/2012
Last updated
01/18/2012
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