Healthcare Provider Details

I. General information

NPI: 1255306999
Provider Name (Legal Business Name): DAVID D OLSON DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10931 RAVEN RIDGE RD SUITE 105
RALEIGH NC
27614-6499
US

IV. Provider business mailing address

10931 RAVEN RIDGE RD SUITE 105
RALEIGH NC
27614-6499
US

V. Phone/Fax

Practice location:
  • Phone: 919-845-8212
  • Fax: 919-845-8201
Mailing address:
  • Phone: 919-845-8212
  • Fax: 919-845-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7017
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: