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General NPI Number Information
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NPI Number | 1437361276
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Entity Type | Organization
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Legal Business Name | KAY W. O'LEARY, D.D.S., P.A.
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 2286 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-3924
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Country | US
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Telephone | 941-627-2011
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Fax | 941-627-6716
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Provider Business Mailing Address
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Address Line | 2286 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-3924
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Country | US
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Telephone | 941-627-2011
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Fax | 941-627-6716
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. KAY W. O'LEARY
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Credential | D.D.S., P.A.
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Telephone | 941-627-2011
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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 | DN11658
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License Number State | FL
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