Healthcare Provider Details

I. General information

NPI: 1437028396
Provider Name (Legal Business Name): JAKUB R OLCZYK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 NORTHPARK DR STE B
COLUMBUS IN
47203-4482
US

IV. Provider business mailing address

5712 PRIMROSE AVE
INDIANAPOLIS IN
46220-2724
US

V. Phone/Fax

Practice location:
  • Phone: 812-372-1234
  • Fax:
Mailing address:
  • Phone: 260-443-4779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12015076A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: