Provider Demographics
NPI:1821751587
Name:OLLOM DDS MUDDY CREEK LLC
Entity Type:Organization
Organization Name:OLLOM DDS MUDDY CREEK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-940-8141
Mailing Address - Street 1:2115 ALLENTOWN RD STE C
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1749
Mailing Address - Country:US
Mailing Address - Phone:419-228-4036
Mailing Address - Fax:
Practice Address - Street 1:3650 MUDDY CREEK RD STE 200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2058
Practice Address - Country:US
Practice Address - Phone:513-922-4221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLLOM ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental