Provider Demographics
NPI:1760455117
Name:MINUKHIN, OLGA (DDS)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:MINUKHIN
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 1:29 ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3130
Mailing Address - Country:US
Mailing Address - Phone:603-527-7112
Mailing Address - Fax:603-527-2835
Practice Address - Street 1:29 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3130
Practice Address - Country:US
Practice Address - Phone:603-527-7112
Practice Address - Fax:603-527-2835
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH34041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30302903Medicaid
NH02Y007384NH01OtherANTHEM