Provider Demographics
NPI:1437374964
Name:O'LEARY, THOMAS RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RAYMOND
Last Name:O'LEARY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16419 NORTHCROSS DR STE E
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5008
Mailing Address - Country:US
Mailing Address - Phone:980-689-5073
Mailing Address - Fax:806-895-0769
Practice Address - Street 1:16419 NORTHCROSS DR STE E
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5008
Practice Address - Country:US
Practice Address - Phone:980-689-5073
Practice Address - Fax:980-689-5076
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC67111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice