Provider Demographics
NPI:1528212891
Name:OLITSKY, ALLAN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:J
Last Name:OLITSKY
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 1:1117 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5340
Mailing Address - Country:US
Mailing Address - Phone:215-855-3400
Mailing Address - Fax:215-855-3353
Practice Address - Street 1:1117 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5340
Practice Address - Country:US
Practice Address - Phone:215-855-3400
Practice Address - Fax:215-855-3353
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-016890-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist