Healthcare Provider Details

I. General information

NPI: 1114167426
Provider Name (Legal Business Name): OLEY VALLEY FAMILY DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TOWN CENTRE DR.
OLEY PA
19547
US

IV. Provider business mailing address

PO BOX 272 2 TOWN CENTRE DR.
OLEY PA
19547-0272
US

V. Phone/Fax

Practice location:
  • Phone: 610-987-6746
  • Fax: 610-987-6750
Mailing address:
  • Phone: 610-987-6746
  • Fax: 610-987-6750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDS019114L
License Number StatePA

VIII. Authorized Official

Name: DR. CECIL ROBERT WOLCOTT JR.
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 610-987-6746