MEDICARE: KEVIN J OLSON D.M.D.

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	1223P0221X	Pediatric Dentistry	S6-109	NV

General Provider Information

NPI Number	:	1770718850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN J OLSON D.M.D.

Provider Business Mailing Address
First Line	:	4530 S CARSON ST STE 5
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-6914
Country	:	US
Telephone Number	:	775-461-3800
Fax Number	:	775-461-3801

Provider Business Practice Location Address
First Line	:	4530 S CARSON ST STE 5
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-6914
Country	:	US
Telephone Number	:	775-461-3800
Fax Number	:	775-461-3801

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

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	08/18/2011

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