Provider Demographics
NPI:1437361276
Name:KAY W. O'LEARY, D.D.S., P.A.
Entity Type:Organization
Organization Name:KAY W. O'LEARY, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:O'LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:941-627-2011
Mailing Address - Street 1:2286 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-3924
Mailing Address - Country:US
Mailing Address - Phone:941-627-2011
Mailing Address - Fax:941-627-6716
Practice Address - Street 1:2286 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-3924
Practice Address - Country:US
Practice Address - Phone:941-627-2011
Practice Address - Fax:941-627-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11658261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental