Provider Demographics
NPI:1720142086
Name:OLLER, DEAN H (DDS)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:H
Last Name:OLLER
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 1:5110 COMMERCE SQUARE DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8554
Mailing Address - Country:US
Mailing Address - Phone:317-882-2611
Mailing Address - Fax:317-882-3662
Practice Address - Street 1:5110 COMMERCE SQUARE DR
Practice Address - Street 2:SUITE J
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8554
Practice Address - Country:US
Practice Address - Phone:317-882-2611
Practice Address - Fax:317-882-3662
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009366A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice