Provider Demographics
NPI:1669452157
Name:OLPINSKI, STEFAN STANISLAW (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:STANISLAW
Last Name:OLPINSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEPHAN
Other - Middle Name:S
Other - Last Name:OLPINSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1181 ARMY BLVD
Mailing Address - Street 2:SUITE 2017
Mailing Address - City:JBSA FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:210-221-0826
Mailing Address - Fax:210-221-0824
Practice Address - Street 1:4070 STANLEY RD STE 214
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-2714
Practice Address - Country:US
Practice Address - Phone:210-221-8723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6917122300000X, 1223G0001X
CO7746122300000X
CODEN-77461223G0001X
CODEN.000077461223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice