Provider Demographics
NPI:1841651635
Name:OLRICH, PHILLIP WAYNE (DDS)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:WAYNE
Last Name:OLRICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 41ST ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2510
Mailing Address - Country:US
Mailing Address - Phone:510-658-5483
Mailing Address - Fax:510-658-5484
Practice Address - Street 1:407 41ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2510
Practice Address - Country:US
Practice Address - Phone:510-658-5483
Practice Address - Fax:510-658-5484
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist