Olivia Georgianna Nillissen, DDS

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

ETN1063 Issued in TX

Practice address

8210 Floyd Curl Drive, MSC 8103
San Antonio, TX 78229-3923

Phone

(210) 450-3273

Fax

(210) 450-2223

NPI assigned

Jul 17, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691712000000",
    "number": "1003595166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8210 FLOYD CURL DRIVE, MSC 8103",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293923",
            "telephone_number": "210-450-3273",
            "fax_number": "210-450-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8210 FLOYD CURL DRIVE, MSC 8103",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293923",
            "telephone_number": "210-450-3273",
            "fax_number": "210-450-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NILLISSEN",
        "first_name": "OLIVIA",
        "middle_name": "GEORGIANNA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-17",
        "last_updated": "2023-08-11",
        "certification_date": "2023-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "ETN1063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Student in an Organized Health Care Education/Training Program in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Student in an Organized Health Care Education/Training Program in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.