Basic Information
Provider Information | |||||||||
NPI: | 1669452157 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OLPINSKI | ||||||||
FirstName: | STEFAN | ||||||||
MiddleName: | STANISLAW | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DDS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | OLPINSKI | ||||||||
OtherFirstName: | STEPHAN | ||||||||
OtherMiddleName: | S | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DDS | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1181 ARMY BLVD | ||||||||
Address2: | SUITE 2017 | ||||||||
City: | JBSA FORT SAM HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 78234 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2102210826 | ||||||||
FaxNumber: | 2102210824 | ||||||||
Practice Location | |||||||||
Address1: | 4070 STANLEY RD STE 214 | ||||||||
Address2: |   | ||||||||
City: | JBSA FT SAM HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 782342714 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2102218723 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/19/2006 | ||||||||
LastUpdateDate: | 10/31/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/31/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D6917 | OR | N |   | Dental Providers | Dentist |   | 122300000X | 7746 | CO | N |   | Dental Providers | Dentist |   | 1223G0001X | DEN-7746 | CO | N |   | Dental Providers | Dentist | General Practice | 1223G0001X | D6917 | OR | N |   | Dental Providers | Dentist | General Practice | 1223P0700X | DEN.00007746 | CO | Y |   | Dental Providers | Dentist | Prosthodontics |
No ID Information.