Provider Demographics
NPI:1164957882
Name:OLIVER, KATHLEEN (DMD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 NORTH SCHOOL ST.
Mailing Address - Street 2:KOKUA KALIHI VALLEY HEALTH CENTER
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819
Mailing Address - Country:US
Mailing Address - Phone:808-791-9428
Mailing Address - Fax:808-848-0979
Practice Address - Street 1:2229 NORTH SCHOOL ST.
Practice Address - Street 2:KOKUA KALIHI VALLEY HEALTH CENTER
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:808-791-9428
Practice Address - Fax:808-848-0979
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program