Provider Demographics
NPI:1720622681
Name:OM DENTAL ART, PC
Entity Type:Organization
Organization Name:OM DENTAL ART, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGTYAREVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-845-5533
Mailing Address - Street 1:27 MADISON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2722
Mailing Address - Country:US
Mailing Address - Phone:201-845-5533
Mailing Address - Fax:
Practice Address - Street 1:27 MADISON AVE STE 110
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2722
Practice Address - Country:US
Practice Address - Phone:201-845-5533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty