Provider Demographics
NPI:1396840989
Name:OLENWINE, CYNTHIA HANNER (DMD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:HANNER
Last Name:OLENWINE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:H
Other - Last Name:OLENWINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, MPH
Mailing Address - Street 1:12 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2032
Mailing Address - Country:US
Mailing Address - Phone:610-509-0782
Mailing Address - Fax:
Practice Address - Street 1:511 E 3RD ST UNIT 301
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015
Practice Address - Country:US
Practice Address - Phone:484-526-2460
Practice Address - Fax:484-526-2466
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025813L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232871448OtherTAX ID