Provider Demographics
NPI:1629729504
Name:OLEAN DENTAL STUDIO PLLC
Entity Type:Organization
Organization Name:OLEAN DENTAL STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ DE CASTRO BOLUFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-718-5655
Mailing Address - Street 1:21202 OLEAN BLVD STE E2
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6723
Mailing Address - Country:US
Mailing Address - Phone:941-629-3200
Mailing Address - Fax:941-629-2113
Practice Address - Street 1:21202 OLEAN BLVD STE E2
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6723
Practice Address - Country:US
Practice Address - Phone:941-629-3200
Practice Address - Fax:941-629-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental