Healthcare Provider Details

I. General information

NPI: 1194384925
Provider Name (Legal Business Name): OLGA FAZLYEVA RDH, PHDHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W SCHUYLKILL RD STE G-15A
POTTSTOWN PA
19465-7438
US

IV. Provider business mailing address

351 W SCHUYLKILL RD STE G-15A
POTTSTOWN PA
19465-7438
US

V. Phone/Fax

Practice location:
  • Phone: 610-326-9460
  • Fax:
Mailing address:
  • Phone: 610-326-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: