Provider Demographics
NPI:1124198619
Name:JORN N OLIMPIADA DDS INC
Entity Type:Organization
Organization Name:JORN N OLIMPIADA DDS INC
Other - Org Name:OLYMPICS DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORN
Authorized Official - Middle Name:NATANAUAN
Authorized Official - Last Name:OLIMPIADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-317-9439
Mailing Address - Street 1:15401 HESPERIAN BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3973
Mailing Address - Country:US
Mailing Address - Phone:510-317-9439
Mailing Address - Fax:510-317-9558
Practice Address - Street 1:15401 HESPERIAN BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3973
Practice Address - Country:US
Practice Address - Phone:510-317-9439
Practice Address - Fax:510-317-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty