Provider Demographics
NPI:1962620989
Name:OLIVER, BRIANNA
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 N LOOP 336 W
Mailing Address - Street 2:STE C
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3631
Mailing Address - Country:US
Mailing Address - Phone:936-539-9400
Mailing Address - Fax:936-539-6337
Practice Address - Street 1:2255 N LOOP 336 W
Practice Address - Street 2:STE C
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3631
Practice Address - Country:US
Practice Address - Phone:936-539-9400
Practice Address - Fax:936-539-6337
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice