Provider Demographics
NPI:1659711851
Name:ESTES, OLIVIA MAE FAULKNER (DMD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:MAE FAULKNER
Last Name:ESTES
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 1:1401 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3313
Mailing Address - Country:US
Mailing Address - Phone:185-965-5610
Mailing Address - Fax:859-655-6148
Practice Address - Street 1:103 LANDMARK DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073
Practice Address - Country:US
Practice Address - Phone:859-655-6100
Practice Address - Fax:859-525-0610
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9564122300000X
KY9496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist