Individual
DR. STEPHANIE MARIE OLLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1245 S SUNBURY RD STE 201, WESTERVILLE, OH 43081-9444
(614) 776-0505
Mailing address
7477 RATCHFORD CT, NEW ALBANY, OH 43054-8970
(419) 906-7196
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019029173
IL
1223G0001X
General Practice Dentistry
Primary
30-24892
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/19/2012
Last updated
04/16/2018
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