Basic Information
| Provider Information | |||||||||
| NPI: | 1477680346 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLIVER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | GAIL | ||||||||
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| Credential: | D.D.S., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 626 120TH AVE NE | ||||||||
| Address2: | B-210 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980053077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254531547 | ||||||||
| FaxNumber: | 4256460974 | ||||||||
| Practice Location | |||||||||
| Address1: | 626 120TH AVE NE | ||||||||
| Address2: | B-210 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980053077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254531547 | ||||||||
| FaxNumber: | 4256460974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | DEOOOO6822 | WA | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.