Provider Demographics
NPI:1962842195
Name:OLIVER, WILLIE TRANARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:TRANARD
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 1:555 COALVILLE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-9364
Mailing Address - Country:US
Mailing Address - Phone:615-596-1015
Mailing Address - Fax:
Practice Address - Street 1:52 EXECUTIVE PARK S
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2217
Practice Address - Country:US
Practice Address - Phone:614-292-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014758122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist