MEDICARE: DR. TIMOTHY R OLINGER DDS

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	1223P0221X	Pediatric Dentistry	12008812	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	108615	OTHER	IN	CHILDRENS SPECIAL HEALTH

General Provider Information

NPI Number	:	1619059557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY R OLINGER DDS

Provider Business Mailing Address
First Line	:	10211 DUPONT CIRCLE DRIVE WEST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1625
Country	:	US
Telephone Number	:	260-490-5437
Fax Number	:	260-490-5210

Provider Business Practice Location Address
First Line	:	10211 DUPONT CIRCLE DRIVE WEST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1625
Country	:	US
Telephone Number	:	260-490-5437
Fax Number	:	260-490-5210

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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