Provider Demographics
NPI:1174629802
Name:OLIVER, DOUGLAS EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EDWARD
Last Name:OLIVER
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 1:2200 SAN PABLO AVE
Mailing Address - Street 2:#101
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564
Mailing Address - Country:US
Mailing Address - Phone:510-724-6161
Mailing Address - Fax:510-724-3619
Practice Address - Street 1:2200 SAN PABLO AVE
Practice Address - Street 2:#101
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564
Practice Address - Country:US
Practice Address - Phone:510-724-6161
Practice Address - Fax:510-724-3619
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA032750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist