Provider Demographics
NPI:1902218431
Name:BODEA, OLIVIA (RDHAP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BODEA
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 LA FLOR AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5323
Mailing Address - Country:US
Mailing Address - Phone:714-234-3808
Mailing Address - Fax:714-593-0320
Practice Address - Street 1:10900 LA FLOR AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5323
Practice Address - Country:US
Practice Address - Phone:714-234-3808
Practice Address - Fax:714-593-0320
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP 513124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist