Provider Demographics
NPI:1154339562
Name:RESTREPO, OLGA (DMD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:RESTREPO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1540
Mailing Address - Country:US
Mailing Address - Phone:508-347-5554
Mailing Address - Fax:508-347-7564
Practice Address - Street 1:266 MAIN ST
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1540
Practice Address - Country:US
Practice Address - Phone:508-347-5554
Practice Address - Fax:508-347-7564
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196021223P0221X
MA19484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Not Answered122300000XDental ProvidersDentist