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General NPI Number Information
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NPI Number | 1043856032
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Entity Type | Organization
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Legal Business Name | JEREMY D. OLEN, DMD PLLC
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 07/22/2023
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Provider Practice Location Address
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Address Line | 102 MARISSA WAY
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City | NAZARETH
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State | PA
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Zip | 18064-8770
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Country | US
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Telephone | 610-304-5359
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Fax |
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Provider Business Mailing Address
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Address Line | 102 MARISSA WAY
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City | NAZARETH
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State | PA
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Zip | 18064-8770
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Country | US
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Telephone | 610-304-5359
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JEREMY D. OLEN
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Credential | DMD
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Telephone | 610-304-5359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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