Provider Demographics
NPI:1609511682
Name:KONDRYA, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KONDRYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 LOOKOUT CIR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13209-9680
Mailing Address - Country:US
Mailing Address - Phone:315-383-6514
Mailing Address - Fax:
Practice Address - Street 1:100 INTREPID LN
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2546
Practice Address - Country:US
Practice Address - Phone:315-496-1083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0631361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice