Healthcare Provider Details

I. General information

NPI: 1043489255
Provider Name (Legal Business Name): THOMAS OLLERHEAD, DMD, CAGS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 UNION ST 6
MARLBOROUGH MA
01752-1207
US

IV. Provider business mailing address

126 UNION ST 6
MARLBOROUGH MA
01752-1207
US

V. Phone/Fax

Practice location:
  • Phone: 508-787-0070
  • Fax: 508-787-0071
Mailing address:
  • Phone: 508-787-0070
  • Fax: 508-787-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS R OLLERHEAD
Title or Position: OWNER
Credential: DMD, CAGS
Phone: 508-787-0070