Provider Demographics
NPI:1750461117
Name:OLIVER, LINDA SUE (DDS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 DORSEY AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-7122
Mailing Address - Country:US
Mailing Address - Phone:304-292-6760
Mailing Address - Fax:304-292-3664
Practice Address - Street 1:1321 DORSEY AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-7122
Practice Address - Country:US
Practice Address - Phone:304-292-6760
Practice Address - Fax:304-292-3664
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice