Provider Demographics
NPI:1164632022
Name:HART, OLIVER FRANK II (DMD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:FRANK
Last Name:HART
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2406
Mailing Address - Country:US
Mailing Address - Phone:803-771-4524
Mailing Address - Fax:803-799-9442
Practice Address - Street 1:2414 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2406
Practice Address - Country:US
Practice Address - Phone:803-771-4524
Practice Address - Fax:803-799-9442
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice