Most Relevant Information
Provider Data
| NPI Number: | 1003595166 |
| Provider Name: | OLIVIA GEORGIANNA NILLISSEN DDS |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: | ETN1063 |
Most Important Dates
| Enumeration Date: | 07/17/2023 |
| Last Updated: | 08/11/2023 |
Provider Practice Location
8210 FLOYD CURL DRIVE, MSC 8103
SAN ANTONIO
TX
782293923
Practice Location Phone/Fax
| Phone: | 2104503273 |
| Fax: | 2104502223 |
Provider Mailing Location
8210 FLOYD CURL DRIVE, MSC 8103
SAN ANTONIO
TX
782293923
Provider Mailing Phone/Fax
| Phone: | 2104503273 |
| Fax: | 2104502223 |