Provider Demographics
NPI:1215065461
Name:OLGUIN, ERIC (DDS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:OLGUIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:
Other - Last Name:OLGUIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3750 W MCFADDEN AVE
Mailing Address - Street 2:D
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-1388
Mailing Address - Country:US
Mailing Address - Phone:714-775-7722
Mailing Address - Fax:714-775-6131
Practice Address - Street 1:3750 W MCFADDEN AVE
Practice Address - Street 2:D
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-1388
Practice Address - Country:US
Practice Address - Phone:714-775-7722
Practice Address - Fax:714-775-6131
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9173301Medicare ID - Type UnspecifiedMEDI-CAL PROVIDER NUMBER