MEDICARE: DR. GARY DOUGLAS OLSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30-016467	OH

General Provider Information

NPI Number	:	1336232685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY DOUGLAS OLSON D.D.S.

Provider Business Mailing Address
First Line	:	157 W. CEDAR ST.
Second Line	:	SUITE 206
City	:	AKRON
State	:	OH
Zip	:	44307-2563
Country	:	US
Telephone Number	:	330-253-8711
Fax Number	:	330-253-8711

Provider Business Practice Location Address
First Line	:	157 W CEDAR ST
Second Line	:	SUITE 206
City	:	AKRON
State	:	OH
Zip	:	44307-2564
Country	:	US
Telephone Number	:	330-253-8711
Fax Number	:	330-253-8711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	07/08/2007

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