Provider Demographics
NPI:1063168730
Name:OLLOM DDS PATASKALA LLC
Entity type:Organization
Organization Name:OLLOM DDS PATASKALA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-940-8141
Mailing Address - Street 1:186 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-8527
Mailing Address - Country:US
Mailing Address - Phone:740-739-4111
Mailing Address - Fax:740-739-4007
Practice Address - Street 1:186 E BROAD ST
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8527
Practice Address - Country:US
Practice Address - Phone:740-739-4111
Practice Address - Fax:740-739-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental