Provider Demographics
NPI:1518213347
Name:KOURNOUTAS, OLGA (DDS)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KOURNOUTAS
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 1:19682 HESPERIAN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4752
Mailing Address - Country:US
Mailing Address - Phone:510-782-9942
Mailing Address - Fax:800-668-9530
Practice Address - Street 1:19682 HESPERIAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4752
Practice Address - Country:US
Practice Address - Phone:510-782-9942
Practice Address - Fax:800-668-9530
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice