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General NPI Number Information
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NPI Number | 1619307485
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Entity Type | Individual
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Provider Name | JOEL OLMOS JR. D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 10668 RIVERSIDE DR
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-2319
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Country | US
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Telephone | 818-760-9912
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Fax | 818-760-9913
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Provider Business Mailing Address
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Address Line | 18635 SOLEDAD CANYON RD STE 108
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City | CANYON COUNTRY
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State | CA
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Zip | 91351-3723
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Country | US
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Telephone | 661-299-2525
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Fax |
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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 | 63052
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License Number State | CA
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