Provider Demographics
NPI:1972725166
Name:MISHILEVSKI, OLGA (DDS)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:MISHILEVSKI
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 1:290 FERRY ST
Mailing Address - Street 2:SUITE B2
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3475
Mailing Address - Country:US
Mailing Address - Phone:973-817-8888
Mailing Address - Fax:973-465-1955
Practice Address - Street 1:290 FERRY ST
Practice Address - Street 2:SUITE B2
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3475
Practice Address - Country:US
Practice Address - Phone:973-817-8888
Practice Address - Fax:973-465-1955
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02100301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist