Provider Demographics
NPI:1811192982
Name:VENGCO, OLIVER M (DMD)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:M
Last Name:VENGCO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 GELLERT BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2814
Mailing Address - Country:US
Mailing Address - Phone:650-754-1300
Mailing Address - Fax:650-754-1122
Practice Address - Street 1:2055 GELLERT BLVD STE 4
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2814
Practice Address - Country:US
Practice Address - Phone:650-754-1300
Practice Address - Fax:650-754-1122
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist