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General NPI Number Information
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NPI Number | 1710134101
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Entity Type | Organization
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Legal Business Name | TRACY S OLIVER DDS PC
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 2484 N LANDING RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-3405
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Country | US
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Telephone | 757-471-5480
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Fax | 757-471-7859
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Provider Business Mailing Address
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Address Line | 2484 N LANDING RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-3405
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Country | US
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Telephone | 757-471-5480
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Fax | 757-471-7859
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. TRACY S OLIVER
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Credential | DDS
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Telephone | 757-471-5480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7137
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License Number State | VA
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