Provider Demographics
NPI:1962892612
Name:BACZARA, OLGA (DMD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:BACZARA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BRANDERMILL BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1691
Mailing Address - Country:US
Mailing Address - Phone:410-451-5600
Mailing Address - Fax:410-451-5600
Practice Address - Street 1:2401 BRANDERMILL BLVD STE 140
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1691
Practice Address - Country:US
Practice Address - Phone:410-451-5600
Practice Address - Fax:410-451-5600
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice