Provider Demographics
NPI:1396817664
Name:ZAVULUNOVA, OLGA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:ZAVULUNOVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6511 108TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1847
Mailing Address - Country:US
Mailing Address - Phone:718-459-0591
Mailing Address - Fax:718-275-1355
Practice Address - Street 1:6511 108TH ST STE A
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1847
Practice Address - Country:US
Practice Address - Phone:718-459-0591
Practice Address - Fax:718-275-1355
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0473571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01778936Medicaid