Provider Demographics
NPI:1982007753
Name:ERIC OLGUIN DDS, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:ERIC OLGUIN DDS, A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:OLGUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-775-7722
Mailing Address - Street 1:3750 W MCFADDEN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-1388
Mailing Address - Country:US
Mailing Address - Phone:714-775-7722
Mailing Address - Fax:714-775-6131
Practice Address - Street 1:3750 W MCFADDEN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-1388
Practice Address - Country:US
Practice Address - Phone:714-775-7722
Practice Address - Fax:714-775-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty