Provider Demographics
NPI:1376107995
Name:AKBULUT, OLENA O
Entity Type:Individual
Prefix:
First Name:OLENA
Middle Name:O
Last Name:AKBULUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-4001
Mailing Address - Country:US
Mailing Address - Phone:267-423-1830
Mailing Address - Fax:
Practice Address - Street 1:10501 ACADEMY RD STE A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1137
Practice Address - Country:US
Practice Address - Phone:215-637-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist