Provider Demographics
NPI:1245416023
Name:OLIVER, NEALE RANDOLPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEALE
Middle Name:RANDOLPH
Last Name:OLIVER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:N.
Other - Middle Name:RANDOLPH
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2200 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3505
Mailing Address - Country:US
Mailing Address - Phone:913-649-4978
Mailing Address - Fax:913-649-0926
Practice Address - Street 1:2200 W 75TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3505
Practice Address - Country:US
Practice Address - Phone:913-649-4978
Practice Address - Fax:913-649-0926
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS59071223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics