Provider Demographics
NPI:1295946424
Name:OLEX & MADANY, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:OLEX & MADANY, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADANY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-951-7645
Mailing Address - Street 1:26712 ESTANCIERO DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5409
Mailing Address - Country:US
Mailing Address - Phone:949-916-2257
Mailing Address - Fax:949-916-2257
Practice Address - Street 1:25596 ALICIA PKWY
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5309
Practice Address - Country:US
Practice Address - Phone:949-951-7645
Practice Address - Fax:949-951-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53924122300000X
CA54562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty