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General NPI Number Information
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NPI Number | 1295016608
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Entity Type | Organization
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Legal Business Name | MICAH M. OLLER D.M.D., INC.
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 466 E CALAVERAS BLVD SUITE B
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City | MILPITAS
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State | CA
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Zip | 95035-5453
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Country | US
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Telephone | 408-263-6660
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Fax | 408-263-8409
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Provider Business Mailing Address
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Address Line | 466 E CALAVERAS BLVD SUITE B
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City | MILPITAS
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State | CA
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Zip | 95035-5453
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Country | US
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Telephone | 408-263-6660
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Fax | 408-263-8409
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICAH M. OLLER
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Credential | D.M.D.
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Telephone | 408-263-6660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 45163
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License Number State | CA
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