Healthcare Provider Details

I. General information

NPI: 1366973950
Provider Name (Legal Business Name): DANIEL AMES OLSEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 02/23/2023
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5327
US

IV. Provider business mailing address

455 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5327
US

V. Phone/Fax

Practice location:
  • Phone: 605-217-7000
  • Fax:
Mailing address:
  • Phone: 605-217-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number13581
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3406
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: