Provider Demographics
NPI:1366274037
Name:OLIVE FAMILY DENTAL CARE PLLC
Entity type:Organization
Organization Name:OLIVE FAMILY DENTAL CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:267-984-6764
Mailing Address - Street 1:3821 LOCKHART DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-3080
Mailing Address - Country:US
Mailing Address - Phone:267-984-6764
Mailing Address - Fax:
Practice Address - Street 1:3310 SAM RAYBURN HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454
Practice Address - Country:US
Practice Address - Phone:469-213-2376
Practice Address - Fax:469-213-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental