Provider Demographics
NPI:1750946794
Name:OLLOM DDS TIPP CITY LLC
Entity type:Organization
Organization Name:OLLOM DDS TIPP CITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-667-2417
Mailing Address - Street 1:2115 ALLENTOWN RD
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 1:110 S TIPPECANOE DR
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-3104
Practice Address - Country:US
Practice Address - Phone:937-667-2417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLLOM ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-06
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366754723OtherNPI