Individual
OLIVIA FAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
135 MARKETPLACE BLVD STE 101, JOHNSON CITY, TN 37604-8933
(423) 434-2421
Mailing address
4121 BRADFORD LN, JOHNSON CITY, TN 37601-1064
(276) 365-0435
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12515
TN
Other
Enumeration date
06/17/2024
Last updated
06/17/2024
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