Provider Demographics
NPI:1275594558
Name:OLAES, IRENE SACAMAY (DMD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:SACAMAY
Last Name:OLAES
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 1:12335 WORLD TRADE DR
Mailing Address - Street 2:1B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3716
Mailing Address - Country:US
Mailing Address - Phone:858-487-4683
Mailing Address - Fax:858-487-4690
Practice Address - Street 1:12335 WORLD TRADE DR
Practice Address - Street 2:1B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3716
Practice Address - Country:US
Practice Address - Phone:858-487-4683
Practice Address - Fax:858-487-4690
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice