Provider Demographics
NPI:1316097306
Name:MARCOTTE, OLIVER PUTNAM (DDS)
Entity type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:PUTNAM
Last Name:MARCOTTE
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 1:5905 WING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1257
Mailing Address - Country:US
Mailing Address - Phone:248-851-0430
Mailing Address - Fax:
Practice Address - Street 1:30903 WEST TEN MILE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336
Practice Address - Country:US
Practice Address - Phone:248-426-0077
Practice Address - Fax:248-426-9316
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI92511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice