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NPI Code Detail

MEDICARE: MR. OLEG G KRUTIKOV DDS

MEDICARE:  MR. OLEG G KRUTIKOV  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist48733CA

General Provider Information

NPI Number : 1093907354
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. OLEG G KRUTIKOV DDS
Provider Business Mailing Address
First Line : 6280 VAN NOORD AVE
Second Line :
City : VALLEY GLEN
State : CA
Zip : 91401-3226
Country : US
Telephone Number : 818-908-0188
Fax Number : 818-908-0188
Provider Business Practice Location Address
First Line : 6001 LAUREL CYN BLVD
Second Line :
City : N HOLLYWOOD
State : CA
Zip : 91606-4615
Country : US
Telephone Number : 818-509-9900
Fax Number : 818-509-9909
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2007
Last Update Date : 08/10/2007

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Directions to “ MR. OLEG G KRUTIKOV DDS” Practice Location

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