Active NPI
Michael Douglas Oliver Jr., DDS
- Pediatric Dentistry
- Jonesboro, AR
National Provider Identifier
1447310883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 3460
- Practice address
- 809 Windover Rd
Jonesboro, AR 72401-6010 - Phone
- (205) 710-5555
- NPI assigned
- Dec 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 3460 | AR | Primary |
Addresses
Primary practice location
809 Windover Rd
Jonesboro, AR 72401-6010
Mailing address
809 Windover Rd
Jonesboro, AR 72401-6010
Phone (205) 710-5555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3460 | AR | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491436800000",
"number": "1447310883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "809 WINDOVER RD",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724016010",
"telephone_number": "205-710-5555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "809 WINDOVER RD",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724016010",
"telephone_number": "205-710-5555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVER",
"first_name": "MICHAEL",
"middle_name": "DOUGLAS",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-08",
"last_updated": "2017-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "AR",
"license": "3460",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.