Provider Demographics
NPI:1669691309
Name:RICHARD J. OLIN, DMD, PA
Entity type:Organization
Organization Name:RICHARD J. OLIN, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-381-8968
Mailing Address - Street 1:1361 SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2760
Mailing Address - Country:US
Mailing Address - Phone:732-381-8968
Mailing Address - Fax:732-381-0478
Practice Address - Street 1:1361 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2760
Practice Address - Country:US
Practice Address - Phone:732-381-8968
Practice Address - Fax:732-381-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI014047001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty