Provider Demographics
NPI:1720120009
Name:GUREVICH, OLGA (DDS)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:GUREVICH
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 1:602 AVE T
Mailing Address - Street 2:APT #4J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223
Mailing Address - Country:US
Mailing Address - Phone:646-239-5568
Mailing Address - Fax:
Practice Address - Street 1:2173 A 68 STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:718-621-0827
Practice Address - Fax:718-621-0829
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051355122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02569139Medicaid