Healthcare Provider Details

I. General information

NPI: 1972676807
Provider Name (Legal Business Name): DAVID RUSSELL OLIVER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7655 FIVE MILE RD
CINCINNATI OH
45230
US

IV. Provider business mailing address

7655 FIVE MILE RD SUITE 210
CINCINNATI OH
45230
US

V. Phone/Fax

Practice location:
  • Phone: 513-231-2100
  • Fax: 513-232-6871
Mailing address:
  • Phone: 513-231-2100
  • Fax: 513-232-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number014211
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: