Provider Demographics
NPI:1457591729
Name:DEDIA, OLGA J (DMD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:J
Last Name:DEDIA
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 1:1623 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-783-2273
Mailing Address - Fax:
Practice Address - Street 1:888 SARATOGA AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2639
Practice Address - Country:US
Practice Address - Phone:408-899-4820
Practice Address - Fax:408-899-4821
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist