Healthcare Provider Details

I. General information

NPI: 1851620702
Provider Name (Legal Business Name): DAVID D. OLSON, DDS, MS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
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 Number
License Number State

VIII. Authorized Official

Name: DR. DAVID D OLSON
Title or Position: OWNER
Credential: DDS
Phone: 919-845-8212