NPIMap

Organization Active NPI

Olean Dental Studio PLLC

  • Dental Clinic/Center
  • Port Charlotte, FL
National Provider Identifier
1629729504
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
OLEAN DENTAL STUDIO PLLC
Practice address
21202 Olean Blvd Ste E2
Port Charlotte, FL 33952-6723
Phone
(941) 629-3200
Fax
(941) 629-2113
NPI assigned
Jan 12, 2022
Last updated
Jan 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

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

Authorized official

Name
Alberto Lopez de Castro Bolufer, DDSNPI 1043704786
Title
Owner
Phone
(786) 718-5655

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

21202 Olean Blvd Ste E2
Port Charlotte, FL 33952-6723

Mailing address

21202 Olean Blvd Ste E2
Port Charlotte, FL 33952-6723
Phone (941) 629-3200

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1641945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1629729504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21202 OLEAN BLVD STE E2",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526723",
            "telephone_number": "941-629-3200",
            "fax_number": "941-629-2113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21202 OLEAN BLVD STE E2",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526723",
            "telephone_number": "941-629-3200",
            "fax_number": "941-629-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLEAN DENTAL STUDIO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-12",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "LOPEZ DE CASTRO BOLUFER",
        "authorized_official_first_name": "ALBERTO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-718-5655",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; 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.