Provider Demographics
NPI:1114167426
Name:OLEY VALLEY FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:OLEY VALLEY FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WOLCOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-987-6746
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:2 TOWN CENTRE DR.
Mailing Address - City:OLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19547-0272
Mailing Address - Country:US
Mailing Address - Phone:610-987-6746
Mailing Address - Fax:610-987-6750
Practice Address - Street 1:2 TOWN CENTRE DR.
Practice Address - Street 2:
Practice Address - City:OLEY
Practice Address - State:PA
Practice Address - Zip Code:19547
Practice Address - Country:US
Practice Address - Phone:610-987-6746
Practice Address - Fax:610-987-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019114L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA067286OtherUNITED CONCORDIA