Provider Demographics
NPI:1194384925
Name:FAZLYEVA, OLGA (RDH, PHDHP)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:FAZLYEVA
Suffix:
Gender:F
Credentials:RDH, PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14A KITTERY CT
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-2162
Mailing Address - Country:US
Mailing Address - Phone:484-213-5388
Mailing Address - Fax:
Practice Address - Street 1:14A KITTERY CT
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-2162
Practice Address - Country:US
Practice Address - Phone:484-213-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist