Provider Demographics
NPI:1487230488
Name:ANNA PAHOLIOUK DDS. INC
Entity Type:Organization
Organization Name:ANNA PAHOLIOUK DDS. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHOLIOUK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-392-4222
Mailing Address - Street 1:30492 GATEWAY PL STE 210
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1862
Mailing Address - Country:US
Mailing Address - Phone:949-392-4222
Mailing Address - Fax:949-392-4223
Practice Address - Street 1:30492 GATEWAY PL STE 210
Practice Address - Street 2:
Practice Address - City:RANCHO MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92694-1862
Practice Address - Country:US
Practice Address - Phone:949-392-4222
Practice Address - Fax:949-392-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-20
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental