Individual
JERIAN OUANO BOLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
3 BRIDGE ST, CARTHAGE, NY 13619-1353
(315) 493-3510
Mailing address
3 BRIDGE ST, CARTHAGE, NY 13619-1353
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
025202
NY
Other
Enumeration date
06/26/2012
Last updated
06/26/2012
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