Provider Demographics
NPI:1366881906
Name:OLIVER, KRISTIN MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:OLIVER
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 1:6809 STATE HIGHWAY 14 W STE D
Mailing Address - Street 2:
Mailing Address - City:CLEVER
Mailing Address - State:MO
Mailing Address - Zip Code:65631-6804
Mailing Address - Country:US
Mailing Address - Phone:417-583-2624
Mailing Address - Fax:417-582-2628
Practice Address - Street 1:6809 STATE HIGHWAY 14 W STE D
Practice Address - Street 2:
Practice Address - City:CLEVER
Practice Address - State:MO
Practice Address - Zip Code:65631-6804
Practice Address - Country:US
Practice Address - Phone:417-583-2624
Practice Address - Fax:417-583-2628
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013018052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist