Provider Demographics
NPI:1447473954
Name:OLITSKY, BRIAN MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:OLITSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24840 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7009
Mailing Address - Country:US
Mailing Address - Phone:239-992-9929
Mailing Address - Fax:239-992-9939
Practice Address - Street 1:24840 S TAMIAMI TRL
Practice Address - Street 2:SUITE 3
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7009
Practice Address - Country:US
Practice Address - Phone:239-992-9929
Practice Address - Fax:239-992-9939
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14907122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist