MEDICARE: DR. STEFAN STANISLAW OLPINSKI 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	D6917	OR
2	122300000X	Dentist	7746	CO
3	1223G0001X	General Practice Dentistry	DEN-7746	CO
4	1223G0001X	General Practice Dentistry	D6917	OR
5	1223P0700X	Prosthodontics	DEN.00007746	CO

General Provider Information

NPI Number	:	1669452157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEFAN STANISLAW OLPINSKI DDS

Provider Business Mailing Address
First Line	:	1181 ARMY BLVD
Second Line	:	SUITE 2017
City	:	JBSA FORT SAM HOUSTON
State	:	TX
Zip	:	78234
Country	:	US
Telephone Number	:	210-221-0826
Fax Number	:	210-221-0824

Provider Business Practice Location Address
First Line	:	4070 STANLEY RD STE 214
Second Line	:
City	:	JBSA FT SAM HOUSTON
State	:	TX
Zip	:	78234-2714
Country	:	US
Telephone Number	:	210-221-8723
Fax Number	:

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	10/31/2022

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