Provider Demographics
NPI:1922418144
Name:URIBE, OLGA (DMD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:URIBE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 WINDBREAK TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2373
Mailing Address - Country:US
Mailing Address - Phone:484-868-6283
Mailing Address - Fax:
Practice Address - Street 1:4228 N CENTRAL EXPY UNIT 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-6548
Practice Address - Country:US
Practice Address - Phone:214-526-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20409122300000X
TX336551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist