Provider Demographics
NPI:1427174705
Name:SOBOL, OLGA (DDS)
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:SOBOL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 MORRIS DR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3546
Mailing Address - Country:US
Mailing Address - Phone:718-986-0987
Mailing Address - Fax:
Practice Address - Street 1:67 STATE ROUTE 36
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1432
Practice Address - Country:US
Practice Address - Phone:732-276-4869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052175122300000X
NJ22DI02300500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist