Provider Demographics
NPI:1710092036
Name:OLIVER, RICHARD WATSON JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WATSON
Last Name:OLIVER
Suffix:JR
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 1:5014 NW 27TH CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6545
Mailing Address - Country:US
Mailing Address - Phone:352-376-5155
Mailing Address - Fax:352-376-5257
Practice Address - Street 1:5014 NW 27TH COURT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6545
Practice Address - Country:US
Practice Address - Phone:352-376-5155
Practice Address - Fax:352-376-5257
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN134941223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics