Provider Demographics
NPI:1487658373
Name:OLIVER, BRIAN RAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RAY
Last Name:OLIVER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 HILLCREST RD
Mailing Address - Street 2:STE D
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-3919
Mailing Address - Country:US
Mailing Address - Phone:251-639-0801
Mailing Address - Fax:251-639-1446
Practice Address - Street 1:1100 HILLCREST RD
Practice Address - Street 2:STE D
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3919
Practice Address - Country:US
Practice Address - Phone:251-639-0801
Practice Address - Fax:251-639-1446
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5090OtherSTATE LICENSE NO.