Provider Demographics
NPI:1124637731
Name:OLESKI, MARISA ASHLEY (DMD)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:ASHLEY
Last Name:OLESKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2473 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5325
Mailing Address - Country:US
Mailing Address - Phone:248-930-1126
Mailing Address - Fax:
Practice Address - Street 1:2951 S BALDWIN RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1665
Practice Address - Country:US
Practice Address - Phone:248-391-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016006271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice