Provider Demographics
NPI:1841579273
Name:OLIVER, JAROD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAROD
Middle Name:
Last Name:OLIVER
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 1:400 E GUENTHER ST
Mailing Address - Street 2:#3101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-1694
Mailing Address - Country:US
Mailing Address - Phone:210-677-5003
Mailing Address - Fax:
Practice Address - Street 1:400 E GUENTHER ST
Practice Address - Street 2:#3101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-1694
Practice Address - Country:US
Practice Address - Phone:210-677-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist