Provider Demographics
NPI:1629288469
Name:OLEINICK, ALLAN JEFFREY (DDS)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:JEFFREY
Last Name:OLEINICK
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 1:25915 HARPER AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3770
Mailing Address - Country:US
Mailing Address - Phone:586-776-5945
Mailing Address - Fax:586-776-5948
Practice Address - Street 1:25915 HARPER AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3770
Practice Address - Country:US
Practice Address - Phone:586-776-5945
Practice Address - Fax:586-776-5948
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010135621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice