Provider Demographics
NPI:1619059557
Name:OLINGER, TIMOTHY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:R
Last Name:OLINGER
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 1:10211 DUPONT CIRCLE DRIVE WEST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1625
Mailing Address - Country:US
Mailing Address - Phone:260-490-5437
Mailing Address - Fax:260-490-5210
Practice Address - Street 1:10211 DUPONT CIRCLE DRIVE WEST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1625
Practice Address - Country:US
Practice Address - Phone:260-490-5437
Practice Address - Fax:260-490-5210
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120088121223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN108615OtherCHILDRENS SPECIAL HEALTH