Healthcare Provider Details

I. General information

NPI: 1710092036
Provider Name (Legal Business Name): RICHARD WATSON OLIVER JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 NW 27TH COURT
GAINESVILLE FL
32606-6545
US

IV. Provider business mailing address

5014 NW 27TH CT
GAINESVILLE FL
32606-6545
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-5155
  • Fax: 352-376-5257
Mailing address:
  • Phone: 352-376-5155
  • Fax: 352-376-5257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN13494
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: