MEDICARE: M. JOSEPH OLK, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12532	MO

General Provider Information

NPI Number	:	1417242777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. JOSEPH OLK, DDS, PC

Provider Business Mailing Address
First Line	:	8045 BIG BEND BLVD
Second Line	:	SUITE 203
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2714
Country	:	US
Telephone Number	:	314-918-9666
Fax Number	:

Provider Business Practice Location Address
First Line	:	8045 BIG BEND BLVD
Second Line	:	SUITE 203
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2714
Country	:	US
Telephone Number	:	314-918-9666
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH M OLK
Credential	:	DDS
Telephone Number	:	314-918-9666

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	06/15/2011

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