Provider Demographics
NPI:1750605598
Name:OLIVER, TONI JARDINE (DDS)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:JARDINE
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 1:17625 CRENSHAW BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-3462
Mailing Address - Country:US
Mailing Address - Phone:310-327-6060
Mailing Address - Fax:310-327-6066
Practice Address - Street 1:17625 CRENSHAW BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-3462
Practice Address - Country:US
Practice Address - Phone:310-327-6060
Practice Address - Fax:310-327-6066
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32602122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist