Provider Demographics
NPI:1871538439
Name:BLEICHRODT, OLIN M (DDS)
Entity type:Individual
Prefix:
First Name:OLIN
Middle Name:M
Last Name:BLEICHRODT
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 1:25 NORTH PORTAGE ST
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44230-1349
Mailing Address - Country:US
Mailing Address - Phone:330-658-6983
Mailing Address - Fax:330-658-6883
Practice Address - Street 1:25 NORTH PORTAGE ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:OH
Practice Address - Zip Code:44230-1349
Practice Address - Country:US
Practice Address - Phone:330-658-6983
Practice Address - Fax:330-658-6883
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist