Provider Demographics
NPI:1821248873
Name:KANDOV, OLGA (DMD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:KANDOV
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 SWEETBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1653
Mailing Address - Country:US
Mailing Address - Phone:215-275-6313
Mailing Address - Fax:215-695-5511
Practice Address - Street 1:5737 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-275-6313
Practice Address - Fax:215-695-5511
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0376281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice