Provider Demographics
NPI:1083764906
Name:OLIFERUK, OLEG (DDS)
Entity Type:Individual
Prefix:MR
First Name:OLEG
Middle Name:
Last Name:OLIFERUK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 BLUE RAVINE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3894
Mailing Address - Country:US
Mailing Address - Phone:916-294-0770
Mailing Address - Fax:916-294-0777
Practice Address - Street 1:241 BLUE RAVINE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3894
Practice Address - Country:US
Practice Address - Phone:916-294-0770
Practice Address - Fax:916-294-0777
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist