Provider Demographics
NPI:1245315761
Name:OLIVER, GEORGE D (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:D
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 1:1112 DIVISION STREET
Mailing Address - Street 2:P.O. BOX 356
Mailing Address - City:ORION
Mailing Address - State:IL
Mailing Address - Zip Code:61273-0356
Mailing Address - Country:US
Mailing Address - Phone:309-526-3307
Mailing Address - Fax:309-526-3308
Practice Address - Street 1:1112 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:IL
Practice Address - Zip Code:61273-0356
Practice Address - Country:US
Practice Address - Phone:309-526-3307
Practice Address - Fax:309-526-3308
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190110751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice