Healthcare Provider Details

I. General information

NPI: 1841443009
Provider Name (Legal Business Name): TAYLOR M OLSEN DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31920 DEL OBISPO ST STE 265
SAN JUAN CAPISTRANO CA
92675-3191
US

IV. Provider business mailing address

31920 DEL OBISPO ST STE 265
SAN JUAN CAPISTRANO CA
92675-3191
US

V. Phone/Fax

Practice location:
  • Phone: 949-542-7799
  • Fax: 949-542-7798
Mailing address:
  • Phone: 949-542-7799
  • Fax: 949-542-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number57300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: