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General NPI Number Information
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NPI Number | 1417161308
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Entity Type | Organization
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Legal Business Name | OLGA PROKOPETS, D.D.S. P.C.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2401 W. GLENDALE AVENUE, SUITE 202
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City | GLENDALE
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State | AZ
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Zip | 85021
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Country | US
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Telephone | 602-249-4404
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Fax | 602-249-4416
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Provider Business Mailing Address
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Address Line | 2401 W. GLENDALE AVENUE, SUITE 202
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City | GLENDALE
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State | AZ
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Zip | 85021
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Country | US
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Telephone | 602-249-4404
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Fax | 602-249-4416
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Authorized Official
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Title or Position | OWNER
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Name | DR. OLGA PROKOPETS
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Credential |
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Telephone | 602-249-4404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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