Provider Demographics
NPI:1770642985
Name:RUBTSOVA, OLGA (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:RUBTSOVA
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 1:19301 SATICOY ST STE D
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2358
Mailing Address - Country:US
Mailing Address - Phone:818-772-4222
Mailing Address - Fax:818-772-1503
Practice Address - Street 1:19301 SATICOY ST STE D
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2358
Practice Address - Country:US
Practice Address - Phone:818-772-4222
Practice Address - Fax:818-772-1503
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA544361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice