Healthcare Provider Details

I. General information

NPI: 1487658373
Provider Name (Legal Business Name): BRIAN RAY OLIVER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HILLCREST RD STE D
MOBILE AL
36695-3919
US

IV. Provider business mailing address

1100 HILLCREST RD STE D
MOBILE AL
36695-3919
US

V. Phone/Fax

Practice location:
  • Phone: 251-639-0801
  • Fax: 251-639-1446
Mailing address:
  • Phone: 251-639-0801
  • Fax: 251-639-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5090
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: