Healthcare Provider Details

I. General information

NPI: 1144540568
Provider Name (Legal Business Name): THOMAS OBERT OLSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FAME AVE SUITE 206
HANOVER PA
17331-1587
US

IV. Provider business mailing address

250 FAME AVE SUITE 206
HANOVER PA
17331-1587
US

V. Phone/Fax

Practice location:
  • Phone: 717-637-0202
  • Fax: 717-637-5855
Mailing address:
  • Phone: 717-637-0202
  • Fax: 717-637-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS038290
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: