Provider Demographics
NPI:1609382605
Name:G.OLAGUE, DDS & R. DEZA DDS APC
Entity Type:Organization
Organization Name:G.OLAGUE, DDS & R. DEZA DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-404-1451
Mailing Address - Street 1:25359 MADISON AVE STE 105-106
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9090
Mailing Address - Country:US
Mailing Address - Phone:805-404-1451
Mailing Address - Fax:
Practice Address - Street 1:25359 MADISON AVE STE 105-106
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9090
Practice Address - Country:US
Practice Address - Phone:805-404-1451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA594671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty