Healthcare Provider Details

I. General information

NPI: 1871538439
Provider Name (Legal Business Name): OLIN M BLEICHRODT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NORTH PORTAGE ST
DOYLESTOWN OH
44230-1349
US

IV. Provider business mailing address

25 NORTH PORTAGE ST
DOYLESTOWN OH
44230-1349
US

V. Phone/Fax

Practice location:
  • Phone: 330-658-6983
  • Fax: 330-658-6883
Mailing address:
  • Phone: 330-658-6983
  • Fax: 330-658-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12837
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: