Provider Demographics
NPI:1104199645
Name:THEMO, OLGA V (DDS)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:V
Last Name:THEMO
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 1:240 CENTRAL PARK SOUTH
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-977-7118
Mailing Address - Fax:
Practice Address - Street 1:240 CENTRAL PARK SOUTH
Practice Address - Street 2:SUITE 2G
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-977-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist