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General NPI Number Information
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NPI Number | 1710323209
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Entity Type | Individual
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Provider Name | OLGA JASINA
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Gender | Female
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Dates
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Enumeration Date | 05/11/2013
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 1640 FORTINO BLVD
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City | PUEBLO
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State | CO
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Zip | 81008-1856
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Country | US
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Telephone | 214-680-0443
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Fax | 719-362-4227
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Provider Business Mailing Address
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Address Line | 1640 FORTINO BLVD
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City | PUEBLO
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State | CO
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Zip | 81008-1856
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Country | US
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Telephone | 214-680-0443
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Fax | 719-362-4227
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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 | DS039464
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS039464
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License Number State | PA
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