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General NPI Number Information
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NPI Number | 1114167426
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Entity Type | Organization
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Legal Business Name | OLEY VALLEY FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 2 TOWN CENTRE DR.
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City | OLEY
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State | PA
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Zip | 19547
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Country | US
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Telephone | 610-987-6746
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Fax | 610-987-6750
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Provider Business Mailing Address
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Address Line | PO BOX 272 2 TOWN CENTRE DR.
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City | OLEY
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State | PA
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Zip | 19547-0272
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Country | US
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Telephone | 610-987-6746
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Fax | 610-987-6750
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. CECIL ROBERT WOLCOTT JR.
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Credential | DDS
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Telephone | 610-987-6746
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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 | DS019114L
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License Number State | PA
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