Provider Demographics
NPI:1255562823
Name:SMUTKO, OLGA P (DDS)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:P
Last Name:SMUTKO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:DUDINSKAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2522 DANA STREET
Mailing Address - Street 2:#202
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2803
Mailing Address - Country:US
Mailing Address - Phone:510-848-1055
Mailing Address - Fax:510-848-9100
Practice Address - Street 1:2522 DANA STREET
Practice Address - Street 2:#202
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2803
Practice Address - Country:US
Practice Address - Phone:510-848-1055
Practice Address - Fax:510-848-9100
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA602491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery