Healthcare Provider Details

I. General information

NPI: 1811276330
Provider Name (Legal Business Name): JULIE ELIZABETH OLSON D.D.S, M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3628 N 90TH ST
OMAHA NE
68134-4127
US

IV. Provider business mailing address

3628 N 90TH ST
OMAHA NE
68134-4127
US

V. Phone/Fax

Practice location:
  • Phone: 402-571-1108
  • Fax: 402-571-1477
Mailing address:
  • Phone: 402-571-1108
  • Fax: 402-571-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6825
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: