Provider Demographics
NPI:1083676837
Name:YEPES, OLGA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:YEPES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2503
Mailing Address - Country:US
Mailing Address - Phone:818-242-9595
Mailing Address - Fax:818-242-9524
Practice Address - Street 1:1217 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2503
Practice Address - Country:US
Practice Address - Phone:818-242-9595
Practice Address - Fax:818-242-9524
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA424531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA514989OtherDENTI-CAL PROGRAM