Provider Demographics
NPI:1104965573
Name:OLIVER, DAVID LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
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 1:202 E MAIN ST
Mailing Address - Street 2:PO BOX 477
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-1648
Mailing Address - Country:US
Mailing Address - Phone:270-365-6322
Mailing Address - Fax:270-365-6322
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-1648
Practice Address - Country:US
Practice Address - Phone:270-365-6322
Practice Address - Fax:270-365-6322
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice