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General NPI Number Information
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NPI Number | 1780940213
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Entity Type | Organization
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Legal Business Name | OLTJEN ORTHODONTICS, PA
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 15159 S. BLACKBOB RD.
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City | OLATHE
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State | KS
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Zip | 66062-3304
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Country | US
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Telephone | 913-764-4333
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Fax |
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Provider Business Mailing Address
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Address Line | 15159 S. BLACKBOB RD.
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City | OLATHE
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State | KS
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Zip | 66062-3304
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Country | US
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Telephone | 913-764-4333
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Fax |
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Authorized Official
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Title or Position | DR & OWENER
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Name | DR. JAY MICHAEL OLTJEN
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Credential | ORTHODONTIST
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Telephone | 913-764-4333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6865
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License Number State | KS
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