MEDICARE: DR. SYDNEY OLSON DDS

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	11962	TN

General Provider Information

NPI Number	:	1467185835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SYDNEY OLSON DDS

Provider Business Mailing Address
First Line	:	1680 BONNIE LN
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-1529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1680 BONNIE LN
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-1529
Country	:	US
Telephone Number	:	901-286-3405
Fax Number	:

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

Provider Enumeration Date	:	07/05/2022
Last Update Date	:	07/05/2022

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