Provider Demographics
NPI:1902992258
Name:BUKHOLTS, OLGA (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:BUKHOLTS
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 1:20 W 64TH ST APT 32E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7138
Mailing Address - Country:US
Mailing Address - Phone:646-361-3633
Mailing Address - Fax:
Practice Address - Street 1:11 BROADWAY
Practice Address - Street 2:CITY DENTAL GROUP
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1303
Practice Address - Country:US
Practice Address - Phone:212-425-0505
Practice Address - Fax:212-425-2120
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0488021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics