NPIMap

Organization Active NPI

J Mark Oliver DDS PA

  • General Practice Dentistry
  • Winston Salem, NC
National Provider Identifier
1306933635
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7312 Issued in NC
Legal business name
J MARK OLIVER DDS PA
Practice address
2621 New Walkertown Rd
Winston Salem, NC 27101
Phone
(336) 724-5054
Fax
(336) 724-5033
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Dr. John Mark Oliver, DDSNPI 1851442073
Title
President
Phone
(336) 724-5054

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 7312 NC Primary

Addresses

Primary practice location

2621 New Walkertown Rd
Winston Salem, NC 27101

Mailing address

2621 New Walkertown Rd
Winston Salem, NC 27101
Phone (336) 724-5054

Other identifiers 1

IdentifierTypeStateIssuer
8990168MedicaidNC

National Provider Directory

National Provider Directory

Locations

2621 New Walkertown Rd
Winston Salem, NC 27101
Phone (336) 724-5054

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1306933635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 NEW WALKERTOWN RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27101",
            "telephone_number": "336-724-5054",
            "fax_number": "336-724-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 NEW WALKERTOWN RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27101",
            "telephone_number": "336-724-5054",
            "fax_number": "336-724-5033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J MARK OLIVER DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-724-5054",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8990168",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.