Provider Demographics
NPI:1780113852
Name:SANTILLAN, OLIVIA RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:RAE
Last Name:SANTILLAN
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 1:338 FAIRVIEW CT
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2276
Mailing Address - Country:US
Mailing Address - Phone:972-679-8988
Mailing Address - Fax:
Practice Address - Street 1:230 N DENTON TAP RD STE 115
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2135
Practice Address - Country:US
Practice Address - Phone:972-393-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist