Provider Demographics
NPI:1215106604
Name:VAN, OLIVER V (DDS)
Entity type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:V
Last Name:VAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OAK BROOK CENTER MALL STE 622
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-4745
Mailing Address - Country:US
Mailing Address - Phone:630-368-0020
Mailing Address - Fax:
Practice Address - Street 1:120 OAK BROOK CENTER MALL STE 622
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4745
Practice Address - Country:US
Practice Address - Phone:630-368-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-023710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist