Provider Demographics
NPI:1518081512
Name:OLIVER, DALE WRIGHT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:WRIGHT
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 1:125 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-1511
Mailing Address - Country:US
Mailing Address - Phone:765-653-6349
Mailing Address - Fax:765-653-4065
Practice Address - Street 1:125 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-1511
Practice Address - Country:US
Practice Address - Phone:765-653-6349
Practice Address - Fax:765-653-4065
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120063221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice