Provider Demographics
NPI:1154475325
Name:IGLESIAS, OLGA MIRIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:MIRIAM
Last Name:IGLESIAS
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 1:27830 QUIET SKY PLACE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4108
Mailing Address - Country:US
Mailing Address - Phone:718-614-0328
Mailing Address - Fax:
Practice Address - Street 1:294 GREENBUSH RD
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1933
Practice Address - Country:US
Practice Address - Phone:845-613-7913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0513991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02561306Medicaid