Provider Demographics
NPI:1396489167
Name:OLIVER, DOMINIQUE (DDS)
Entity type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 ROYAL MONTREAL DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-4823
Mailing Address - Country:US
Mailing Address - Phone:469-288-3255
Mailing Address - Fax:
Practice Address - Street 1:600 E BAILEY BOSWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-3566
Practice Address - Country:US
Practice Address - Phone:682-285-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX407631223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program