Provider Demographics
NPI:1477393049
Name:ATKINSON, OLIVER WARREN (DMD)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:WARREN
Last Name:ATKINSON
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 1:1463 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2565
Mailing Address - Country:US
Mailing Address - Phone:208-800-2075
Mailing Address - Fax:
Practice Address - Street 1:11901 KEY PENINSULA HWY NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98329-5050
Practice Address - Country:US
Practice Address - Phone:360-475-3729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61551678122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist