Provider Demographics
NPI:1144890690
Name:JACONETTE, OLIVIA (DDS)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:
Last Name:JACONETTE
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 1:2620 TENDERFOOT HILL ST STE 210
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8356
Mailing Address - Country:US
Mailing Address - Phone:907-301-6742
Mailing Address - Fax:
Practice Address - Street 1:11837 E ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3857
Practice Address - Country:US
Practice Address - Phone:303-779-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00204799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist