Provider Demographics
NPI:1689758112
Name:PAUL T. OLENYN, D.D.S., LTD.
Entity Type:Organization
Organization Name:PAUL T. OLENYN, D.D.S., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:OLENYN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-978-8560
Mailing Address - Street 1:5207 LYNGATE CT # A
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1660
Mailing Address - Country:US
Mailing Address - Phone:703-978-8560
Mailing Address - Fax:
Practice Address - Street 1:5207 LYNGATE CT # A
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1660
Practice Address - Country:US
Practice Address - Phone:703-978-8560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010049081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty