Provider Demographics
NPI:1114159712
Name:AARON, OLIVIA DANIELLE (RDH)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:DANIELLE
Last Name:AARON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-2436
Mailing Address - Fax:618-724-2571
Practice Address - Street 1:27 CIRCLE ST
Practice Address - Street 2:
Practice Address - City:ZEIGLER
Practice Address - State:IL
Practice Address - Zip Code:62999-1148
Practice Address - Country:US
Practice Address - Phone:618-596-2411
Practice Address - Fax:618-596-6559
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020012747124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist