Provider Demographics
NPI:1851446058
Name:GONCHAROVA, OLGA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:GONCHAROVA
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 1:316 HOPE ST
Mailing Address - Street 2:FAMILY DENTAL PRACTICE
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-1704
Mailing Address - Country:US
Mailing Address - Phone:203-353-8532
Mailing Address - Fax:203-353-8542
Practice Address - Street 1:316 HOPE ST
Practice Address - Street 2:FAMILY DENTAL PRACTICE
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906-1704
Practice Address - Country:US
Practice Address - Phone:203-353-8532
Practice Address - Fax:203-353-8542
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0089841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice