Provider Demographics
NPI:1093907354
Name:KRUTIKOV, OLEG G (DDS)
Entity Type:Individual
Prefix:MR
First Name:OLEG
Middle Name:G
Last Name:KRUTIKOV
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 1:6280 VAN NOORD AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY GLEN
Mailing Address - State:CA
Mailing Address - Zip Code:91401-3226
Mailing Address - Country:US
Mailing Address - Phone:818-908-0188
Mailing Address - Fax:818-908-0188
Practice Address - Street 1:6001 LAUREL CYN BLVD
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4615
Practice Address - Country:US
Practice Address - Phone:818-509-9900
Practice Address - Fax:818-509-9909
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48733122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist