MEDICARE: DR. BRIAN RAY OLIVER D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	5090	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5090	OTHER	AL	STATE LICENSE NO.

General Provider Information

NPI Number	:	1487658373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN RAY OLIVER D.M.D.

Provider Business Mailing Address
First Line	:	1100 HILLCREST RD
Second Line	:	STE D
City	:	MOBILE
State	:	AL
Zip	:	36695-3919
Country	:	US
Telephone Number	:	251-639-0801
Fax Number	:	251-639-1446

Provider Business Practice Location Address
First Line	:	1100 HILLCREST RD
Second Line	:	STE D
City	:	MOBILE
State	:	AL
Zip	:	36695-3919
Country	:	US
Telephone Number	:	251-639-0801
Fax Number	:	251-639-1446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/08/2007

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