Provider Demographics
NPI:1629174354
Name:OLLMAN, PETER M (DMD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:OLLMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1459
Mailing Address - Country:US
Mailing Address - Phone:541-708-0347
Mailing Address - Fax:802-748-8513
Practice Address - Street 1:836 E MAIN ST
Practice Address - Street 2:STE #2
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7115
Practice Address - Country:US
Practice Address - Phone:541-858-0740
Practice Address - Fax:541-776-5342
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9378122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT000-1944Medicaid
NH9900-1944Medicaid