Provider Demographics
NPI:1407953169
Name:OLIVER, ROBERT S (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:OLIVER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8901 BARNETT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-9564
Mailing Address - Country:US
Mailing Address - Phone:707-823-5207
Mailing Address - Fax:707-823-8197
Practice Address - Street 1:8901 BARNETT VALLEY RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-9564
Practice Address - Country:US
Practice Address - Phone:707-823-5207
Practice Address - Fax:707-823-8197
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA438331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry