Healthcare Provider Details

I. General information

NPI: 1245938703
Provider Name (Legal Business Name): DIONZHANE OLIVER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 W 85TH ST
INGLEWOOD CA
90305-1827
US

IV. Provider business mailing address

5198 ARLINGTON AVE # 178
RIVERSIDE CA
92504-2603
US

V. Phone/Fax

Practice location:
  • Phone: 323-753-2522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number110110
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: