Provider Demographics
NPI:1841576873
Name:OLEA, VIRGINIA LEE (RDH LAP)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:LEE
Last Name:OLEA
Suffix:
Gender:F
Credentials:RDH LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:CULVER
Mailing Address - State:OR
Mailing Address - Zip Code:97734-0205
Mailing Address - Country:US
Mailing Address - Phone:541-390-5358
Mailing Address - Fax:
Practice Address - Street 1:4508 SW EUREKA LN
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-8828
Practice Address - Country:US
Practice Address - Phone:541-390-5358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5423124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist