MEDICARE: DR. RAGHAVENDRA OLETY 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
1	122300000X	Dentist	56998	CA

General Provider Information

NPI Number	:	1477704104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAGHAVENDRA OLETY DDS

Provider Business Mailing Address
First Line	:	5400 RUNNING SPRING WAY
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92887-6417
Country	:	US
Telephone Number	:	405-209-1143
Fax Number	:

Provider Business Practice Location Address
First Line	:	4180 WOODRUFF AVE
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-3144
Country	:	US
Telephone Number	:	562-938-9514
Fax Number	:

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

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	03/31/2026

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