Healthcare Provider Details

I. General information

NPI: 1104721299
Provider Name (Legal Business Name): AMBER NICOLE OLSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 W PATRICK ST STE B7
FREDERICK MD
21702-9062
US

IV. Provider business mailing address

1031 CORBETT ST
HAGERSTOWN MD
21740-7303
US

V. Phone/Fax

Practice location:
  • Phone: 301-695-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number8483
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: