Provider Demographics
NPI:1508053844
Name:OLEARY, KEVIN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:OLEARY
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:N14 W23755 STONERIDGE DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1147
Mailing Address - Country:US
Mailing Address - Phone:262-523-0220
Mailing Address - Fax:262-523-0390
Practice Address - Street 1:N14 W23755 STONERIDGE DR
Practice Address - Street 2:SUITE 260
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1147
Practice Address - Country:US
Practice Address - Phone:262-523-0220
Practice Address - Fax:262-523-0390
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1050GW261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center