Provider Demographics
NPI:1942376199
Name:OLEJKO, TERRY DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:DAVID
Last Name:OLEJKO
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 1:615 COPELAND MILL RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8904
Mailing Address - Country:US
Mailing Address - Phone:614-895-8400
Mailing Address - Fax:614-895-8115
Practice Address - Street 1:615 COPELAND MILL RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8904
Practice Address - Country:US
Practice Address - Phone:614-895-8400
Practice Address - Fax:614-895-8115
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300151991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0570645Medicaid
OH6152Medicare UPIN
OHOLO573234Medicare ID - Type UnspecifiedDELAWARE, OH
OH0570645Medicaid