Provider Demographics
NPI:1457368144
Name:DE OLIVEIRA, AUGUST BORGES JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUGUST
Middle Name:BORGES
Last Name:DE OLIVEIRA
Suffix:JR
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 1:5400 BALBOA BLVD STE 231
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5233
Mailing Address - Country:US
Mailing Address - Phone:818-783-2981
Mailing Address - Fax:
Practice Address - Street 1:5400 BALBOA BLVD STE 231
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5233
Practice Address - Country:US
Practice Address - Phone:818-783-2981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44457122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist