MEDICARE: OLGA J DEDIA DMD

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	122300000X	Dentist	58081	CA

General Provider Information

NPI Number	:	1457591729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA J DEDIA DMD

Provider Business Mailing Address
First Line	:	1623 EUREKA RD
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3027
Country	:	US
Telephone Number	:	916-783-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	888 SARATOGA AVE STE 100
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-2639
Country	:	US
Telephone Number	:	408-899-4820
Fax Number	:	408-899-4821

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

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	01/23/2018

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