Provider Demographics
NPI:1093163446
Name:OLIVE, GARRETT DON (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:DON
Last Name:OLIVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 NW HIGHWAY 270
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-1734
Mailing Address - Country:US
Mailing Address - Phone:580-256-6054
Mailing Address - Fax:580-256-6057
Practice Address - Street 1:809 NW HIGHWAY 270
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-1734
Practice Address - Country:US
Practice Address - Phone:580-256-6054
Practice Address - Fax:580-256-6057
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6805122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist