Provider Demographics
NPI:1679567911
Name:POLINOVSKY, OLGA (DDS)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:POLINOVSKY
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 1:1414 BAY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1610
Mailing Address - Country:US
Mailing Address - Phone:310-409-6208
Mailing Address - Fax:
Practice Address - Street 1:1414 BAY ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1610
Practice Address - Country:US
Practice Address - Phone:310-409-6208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50689122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist