MEDICARE: DR. JEREMY DANIEL OLEN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS039661	PA

General Provider Information

NPI Number	:	1396175741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY DANIEL OLEN D.M.D.

Provider Business Mailing Address
First Line	:	2228 STATE HILL RD
Second Line	:
City	:	READING
State	:	PA
Zip	:	19610-1904
Country	:	US
Telephone Number	:	610-379-3248
Fax Number	:

Provider Business Practice Location Address
First Line	:	2228 STATE HILL RD
Second Line	:
City	:	READING
State	:	PA
Zip	:	19610-1904
Country	:	US
Telephone Number	:	610-372-8406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2013
Last Update Date	:	11/08/2021

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