Healthcare Provider Details

I. General information

NPI: 1346824380
Provider Name (Legal Business Name): CAREFREE RESTORATIVE DENTAL ARTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7518 E ELBOW BND STE A1
CAREFREE AZ
85377-9605
US

IV. Provider business mailing address

PO BOX 2268
CAREFREE AZ
85377-2268
US

V. Phone/Fax

Practice location:
  • Phone: 480-488-9735
  • Fax: 480-575-1427
Mailing address:
  • Phone: 480-488-9735
  • Fax: 480-575-1427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BLAKE JEROME OLSON
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 480-488-9735