Provider Demographics
NPI:1821344482
Name:OLMOS, STEVEN RUBEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RUBEN
Last Name:OLMOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7879 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0623
Mailing Address - Country:US
Mailing Address - Phone:619-466-2774
Mailing Address - Fax:619-466-2873
Practice Address - Street 1:7879 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0623
Practice Address - Country:US
Practice Address - Phone:619-466-2774
Practice Address - Fax:619-466-2873
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist