Provider Demographics
NPI:1790136083
Name:OLIVEIRA, BRIAN JOSPEH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOSPEH
Last Name:OLIVEIRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6013 MCPHERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-1305
Mailing Address - Country:US
Mailing Address - Phone:513-673-1326
Mailing Address - Fax:
Practice Address - Street 1:6650 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-4742
Practice Address - Country:US
Practice Address - Phone:314-457-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030750122300000X
MO20170266771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist