Healthcare Provider Details

I. General information

NPI: 1750838785
Provider Name (Legal Business Name): OLGA S SPIVAK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 MAPLE AVE W STE E
VIENNA VA
22180-4312
US

IV. Provider business mailing address

303 MAPLE AVE W STE E
VIENNA VA
22180-4312
US

V. Phone/Fax

Practice location:
  • Phone: 703-260-2500
  • Fax:
Mailing address:
  • Phone: 917-817-7369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1857371
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: