Provider Demographics
NPI:1790001022
Name:OLIVER, FERNANDO L (DMD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:L
Last Name:OLIVER
Suffix:
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 1:195 S WESTMONTE DR STE 1112
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-4219
Mailing Address - Country:US
Mailing Address - Phone:407-774-8834
Mailing Address - Fax:
Practice Address - Street 1:195 S WESTMONTE DR STE 1112
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-4219
Practice Address - Country:US
Practice Address - Phone:407-774-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL87411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice