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General NPI Number Information
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NPI Number | 1093907354
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Entity Type | Individual
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Provider Name | OLEG G KRUTIKOV DDS
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Gender | Male
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 6001 LAUREL CYN BLVD
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City | N HOLLYWOOD
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State | CA
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Zip | 91606-4615
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Country | US
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Telephone | 818-509-9900
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Fax | 818-509-9909
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Provider Business Mailing Address
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Address Line | 6280 VAN NOORD AVE
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City | VALLEY GLEN
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State | CA
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Zip | 91401-3226
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Country | US
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Telephone | 818-908-0188
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Fax | 818-908-0188
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 48733
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License Number State | CA
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