Provider Demographics
NPI:1730408238
Name:MARSHALL S. OLECH, DDS,PC
Entity type:Organization
Organization Name:MARSHALL S. OLECH, DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLECH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-944-0658
Mailing Address - Street 1:711 W NORTH AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1174
Mailing Address - Country:US
Mailing Address - Phone:312-944-0658
Mailing Address - Fax:312-944-0531
Practice Address - Street 1:711 W NORTH AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1174
Practice Address - Country:US
Practice Address - Phone:312-944-0658
Practice Address - Fax:312-944-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019013659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty