Provider Demographics
NPI:1326112749
Name:OLIVIER, JAN SUSAN (DMD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:SUSAN
Last Name:OLIVIER
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 1:2821 N BALLAS RD STE 140
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2377
Mailing Address - Country:US
Mailing Address - Phone:314-432-5544
Mailing Address - Fax:
Practice Address - Street 1:2821 N BALLAS RD STE 140
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2377
Practice Address - Country:US
Practice Address - Phone:314-432-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19991394771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice