Healthcare Provider Details

I. General information

NPI: 1295797926
Provider Name (Legal Business Name): FAITH L OLIVER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W COLORADO BLVD 222
DALLAS TX
75208-2363
US

IV. Provider business mailing address

206 COZY LN
CEDAR HILL TX
75104-3232
US

V. Phone/Fax

Practice location:
  • Phone: 214-339-7500
  • Fax: 214-339-7503
Mailing address:
  • Phone: 469-774-2308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number18305
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: