Provider Demographics
NPI:1699537183
Name:OLISHKEVYCH, OLEKSANDRA
Entity type:Individual
Prefix:
First Name:OLEKSANDRA
Middle Name:
Last Name:OLISHKEVYCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WASHINGTON PARK APT 3
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1940
Mailing Address - Country:US
Mailing Address - Phone:872-772-0990
Mailing Address - Fax:
Practice Address - Street 1:746 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-2116
Practice Address - Country:US
Practice Address - Phone:508-429-4445
Practice Address - Fax:508-429-4445
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN10000488122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist