Provider Demographics
NPI:1578781522
Name:OLSZEWSKI, RONALD M (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:M
Last Name:OLSZEWSKI
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 1:6115 28TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6946
Mailing Address - Country:US
Mailing Address - Phone:616-949-1700
Mailing Address - Fax:616-224-2937
Practice Address - Street 1:6115 28TH STREET SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-6946
Practice Address - Country:US
Practice Address - Phone:616-949-1700
Practice Address - Fax:616-224-2937
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010137971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice