MEDICARE: DR. OLGA FONSECA D.D.S.

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
1	1223E0200X	Endodontics	DEN5254	DC

General Provider Information

NPI Number	:	1124177605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLGA FONSECA D.D.S.

Provider Business Mailing Address
First Line	:	1350 CONNECTICUT AVE NW
Second Line	:	SUITE 305
City	:	WASHINGTON
State	:	DC
Zip	:	20036-1722
Country	:	US
Telephone Number	:	202-887-5442
Fax Number	:	202-223-1841

Provider Business Practice Location Address
First Line	:	1350 CONNECTICUT AVE NW
Second Line	:	SUITE 305
City	:	WASHINGTON
State	:	DC
Zip	:	20036-1722
Country	:	US
Telephone Number	:	202-887-5442
Fax Number	:	202-223-1841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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