Provider Demographics
NPI:1164628558
Name:OLAH, DIAN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIAN
Middle Name:M
Last Name:OLAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 CONCORD ST
Mailing Address - Street 2:APT B
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3779
Mailing Address - Country:US
Mailing Address - Phone:310-975-9799
Mailing Address - Fax:
Practice Address - Street 1:9615 BRIGHTON WAY
Practice Address - Street 2:STE 222
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5131
Practice Address - Country:US
Practice Address - Phone:310-858-9212
Practice Address - Fax:310-858-9214
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51020122300000X
FL10588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist