Provider Demographics
NPI:1609890722
Name:ROBERT W. OLIVER II, DDS, INC.
Entity Type:Organization
Organization Name:ROBERT W. OLIVER II, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-584-6448
Mailing Address - Street 1:2105 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4613
Mailing Address - Country:US
Mailing Address - Phone:918-584-6448
Mailing Address - Fax:918-582-4124
Practice Address - Street 1:25 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1109
Practice Address - Country:US
Practice Address - Phone:918-584-6448
Practice Address - Fax:918-582-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty