Provider Demographics
NPI:1619098258
Name:OLTJEN, JAY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:M
Last Name:OLTJEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15159 S. BLACK BOB ROAD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062
Mailing Address - Country:US
Mailing Address - Phone:913-764-4333
Mailing Address - Fax:913-764-3393
Practice Address - Street 1:15159 S. BLACK BOB ROAD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062
Practice Address - Country:US
Practice Address - Phone:913-764-4333
Practice Address - Fax:913-764-3393
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS68651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics