Provider Demographics
NPI:1295016608
Name:MICAH M. OLLER D.M.D., INC.
Entity Type:Organization
Organization Name:MICAH M. OLLER D.M.D., INC.
Other - Org Name:ENDODONTICS OF SILICON VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-263-6660
Mailing Address - Street 1:466 E CALAVERAS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5453
Mailing Address - Country:US
Mailing Address - Phone:408-263-6660
Mailing Address - Fax:408-263-8409
Practice Address - Street 1:466 E CALAVERAS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5453
Practice Address - Country:US
Practice Address - Phone:408-263-6660
Practice Address - Fax:408-263-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451631223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty