Healthcare Provider Details

I. General information

NPI: 1659449023
Provider Name (Legal Business Name): JCOLSON DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 WAILEA IKE PL SUITE B104
WAILEA HI
96753-6521
US

IV. Provider business mailing address

161 WAILEA IKE PL SUITE B104
WAILEA HI
96753-6521
US

V. Phone/Fax

Practice location:
  • Phone: 808-875-8555
  • Fax:
Mailing address:
  • Phone: 808-875-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2487
License Number StateHI

VIII. Authorized Official

Name: DR. JEFFREY C OLSON
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 808-875-8555