Provider Demographics
NPI:1790174035
Name:THOMAS R O'LEARY DDS PA
Entity Type:Organization
Organization Name:THOMAS R O'LEARY DDS PA
Other - Org Name:THOMAS O'LEARY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:O'LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-775-4676
Mailing Address - Street 1:701 HARTNESS RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3424
Mailing Address - Country:US
Mailing Address - Phone:704-775-4676
Mailing Address - Fax:704-775-4677
Practice Address - Street 1:701 HARTNESS RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3424
Practice Address - Country:US
Practice Address - Phone:704-775-4676
Practice Address - Fax:704-775-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty