MEDICARE: RAGHAVENDRA OLETY, DDS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1174463988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAGHAVENDRA OLETY, DDS, INC.

Provider Business Mailing Address
First Line	:	5400 RUNNING SPRING WAY
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92887-6417
Country	:	US
Telephone Number	:	405-209-1143
Fax Number	:

Provider Business Practice Location Address
First Line	:	4180 WOODRUFF AVE
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-3144
Country	:	US
Telephone Number	:	562-938-9514
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAGHAVENDRA OLETY
Credential	:	DDS
Telephone Number	:	405-209-1143

Provider Enumeration Date	:	03/31/2026
Last Update Date	:	03/31/2026

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