Provider Demographics
NPI:1861383036
Name:OLIVA, VENUS NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:VENUS
Middle Name:NICOLE
Last Name:OLIVA
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 1:1023 CYPRESS HILL LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-6244
Mailing Address - Country:US
Mailing Address - Phone:786-393-1423
Mailing Address - Fax:
Practice Address - Street 1:2801 EUBANK BLVD NE STE J
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1300
Practice Address - Country:US
Practice Address - Phone:505-299-9606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1119511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice