Provider Demographics
NPI:1043856032
Name:JEREMY D. OLEN, DMD PLLC
Entity Type:Organization
Organization Name:JEREMY D. OLEN, DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-304-5359
Mailing Address - Street 1:102 MARISSA WAY
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-8770
Mailing Address - Country:US
Mailing Address - Phone:610-304-5359
Mailing Address - Fax:
Practice Address - Street 1:102 MARISSA WAY
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8770
Practice Address - Country:US
Practice Address - Phone:610-304-5359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental