Provider Demographics
NPI:1740021278
Name:OLMOS, MARISSA (DMD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:OLMOS
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 1:6117 E EDGEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-1050
Mailing Address - Country:US
Mailing Address - Phone:623-824-2649
Mailing Address - Fax:
Practice Address - Street 1:8591 E BELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1305
Practice Address - Country:US
Practice Address - Phone:480-367-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD012167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist