Provider Demographics
NPI:1619786597
Name:OLIVIER, SHANNON DENIS (DT-DO-10156558)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:DENIS
Last Name:OLIVIER
Suffix:
Gender:M
Credentials:DT-DO-10156558
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 OAKMONT WAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6459
Mailing Address - Country:US
Mailing Address - Phone:541-762-2747
Mailing Address - Fax:
Practice Address - Street 1:2377 OAKMONT WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6459
Practice Address - Country:US
Practice Address - Phone:542-762-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DT-DO-10156558122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist