Provider Demographics
NPI:1902038557
Name:DR. OLGA BACZARA
Entity Type:Organization
Organization Name:DR. OLGA BACZARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-451-2687
Mailing Address - Street 1:2401 BRANDERMILL BLVD.
Mailing Address - Street 2:STE. 140
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054
Mailing Address - Country:US
Mailing Address - Phone:410-451-5600
Mailing Address - Fax:
Practice Address - Street 1:2401 BRANDERMILL BLVD.
Practice Address - Street 2:STE. 140
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054
Practice Address - Country:US
Practice Address - Phone:410-451-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty