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Provider Information for 1184153009

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. OLGA DEGTYAREVA DDS

Gender: FEMALE

Individual NPI: 1184153009

Calendar   Last Updated:  2018-09-04
  Certification Date: 

Details

Name Value
NPI 1184153009
Enumeration Date 2017-06-05
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1725 SHEEPSHEAD BAY RD
BROOKLYN, NY 11235-3606
United States

Phone: 718-743-0299 | Fax: 718-743-1468
View Map External Link
Primary Practice Address 1725 SHEEPSHEAD BAY RD
BROOKLYN, NY 11235
United States

Phone: 718-743-0299 | Fax: 718-743-1468
View Map External Link
Secondary Practice Address 385 TREMONT AVE
EAST ORANGE, NJ 07018-1023
United States

Phone: 973-676-1000 | Fax:
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice NY 059865
No 390200000X - Student in an Organized Health Care Education/Training Program