1760455117 NPI number — OLGA MINUKHIN DDS

Table of content: OLGA MINUKHIN DDS (NPI 1760455117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760455117 NPI number — OLGA MINUKHIN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINUKHIN
Provider First Name:
OLGA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760455117
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 ELLIOTT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LACONIA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03246-3130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-527-7112
Provider Business Mailing Address Fax Number:
603-527-2835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 ELLIOTT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LACONIA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03246-3130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-527-7112
Provider Business Practice Location Address Fax Number:
603-527-2835
Provider Enumeration Date:
02/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  3404 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30302903 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02Y007384NH01 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".