Provider Demographics
NPI:1487107850
Name:PAHOLIOUK, ANNA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:PAHOLIOUK
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 1:30492 GATEWAY PL STE 210
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1862
Mailing Address - Country:US
Mailing Address - Phone:949-392-4222
Mailing Address - Fax:949-392-4223
Practice Address - Street 1:30492 GATEWAY PL STE 210
Practice Address - Street 2:
Practice Address - City:RANCHO MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92694-1862
Practice Address - Country:US
Practice Address - Phone:949-392-4222
Practice Address - Fax:949-392-4223
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1004341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice