Provider Demographics
NPI:1417161308
Name:OLGA PROKOPETS, D.D.S. P.C.
Entity Type:Organization
Organization Name:OLGA PROKOPETS, D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROKOPETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-249-4404
Mailing Address - Street 1:2401 W. GLENDALE AVENUE, SUITE 202
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85021
Mailing Address - Country:US
Mailing Address - Phone:602-249-4404
Mailing Address - Fax:602-249-4416
Practice Address - Street 1:2401 W. GLENDALE AVENUE, SUITE 202
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85021
Practice Address - Country:US
Practice Address - Phone:602-249-4404
Practice Address - Fax:602-249-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental