Healthcare Provider Details

I. General information

NPI: 1841938008
Provider Name (Legal Business Name): OLIVIA ALEXANDRA CAVAZOS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 STRAKA TER
OKLAHOMA CITY OK
73139-2544
US

IV. Provider business mailing address

15604 POTOMAC DR
EDMOND OK
73013-0035
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-6688
  • Fax:
Mailing address:
  • Phone: 405-694-0949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number7565
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7565
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: