Provider Demographics
NPI:1487848693
Name:TERRY D. OLEJKO, D.D.S., M.S.
Entity Type:Organization
Organization Name:TERRY D. OLEJKO, D.D.S., M.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:OLEJKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-368-5566
Mailing Address - Street 1:551 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1493
Mailing Address - Country:US
Mailing Address - Phone:740-368-5566
Mailing Address - Fax:740-368-5597
Practice Address - Street 1:551 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1493
Practice Address - Country:US
Practice Address - Phone:740-368-5566
Practice Address - Fax:740-368-5597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-51991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T38024Medicare UPIN
OH9934093Medicare PIN
OH9934092Medicare PIN