Provider Demographics
NPI:1154878551
Name:NDOUTOUME, OLIVIA JOELLE (DDS)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JOELLE
Last Name:NDOUTOUME
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 JUDSON RD
Mailing Address - Street 2:KOOL SMILES
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4643
Mailing Address - Country:US
Mailing Address - Phone:650-307-7135
Mailing Address - Fax:
Practice Address - Street 1:2801 BILL OWENS PKWY
Practice Address - Street 2:APT 279
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2115
Practice Address - Country:US
Practice Address - Phone:650-307-7135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX325761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice