Individual provider Active NPI

Olga Zavulunova, DDS

  • General Practice Dentistry
  • Forest Hills, NY
National Provider Identifier
1396817664
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
047357 Issued in NY
Practice address
6511 108TH St Ste a
Forest Hills, NY 11375-1847
Phone
(718) 459-0591
Fax
(718) 275-1355
NPI assigned
Nov 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 047357 NY Primary

Addresses

Primary practice location

6511 108TH St Ste a
Forest Hills, NY 11375-1847

Mailing address

6511 108TH St Ste a
Forest Hills, NY 11375-1847
Phone (718) 459-0591

Other practice location 1

9876 Queens Blvd
Ste 1E
Rego Park, NY 11374-4300
Phone (718) 459-0591

Other identifiers 1

IdentifierTypeStateIssuer
01778936MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
047357NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Queens Smile Dental P.C. General Practice Past Accepting new patients
Americhoice Dental Care PC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1396817664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6511 108TH ST STE A",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113751847",
            "telephone_number": "718-459-0591",
            "fax_number": "718-275-1355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6511 108TH ST STE A",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113751847",
            "telephone_number": "718-459-0591",
            "fax_number": "718-275-1355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9876 Queens Blvd",
            "address_2": "Ste 1E",
            "address_purpose": "LOCATION",
            "city": "Rego Park",
            "state": "NY",
            "postal_code": "113744300",
            "country_code": "US",
            "telephone_number": "718-459-0591",
            "fax_number": "718-275-1355",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZAVULUNOVA",
        "first_name": "OLGA",
        "name_prefix": "Mrs.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "047357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01778936",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.