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General NPI Number Information
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NPI Number | 1023213998
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Entity Type | Organization
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Legal Business Name | DONNA B OLSEN DDS & RICHARD A OLSEN DDS, PA
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 367 WILLIAMSON RD SUITE 103
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City | MOORESVILLE
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State | NC
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Zip | 28117-5944
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Country | US
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Telephone | 704-662-9111
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Fax | 704-662-9112
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Provider Business Mailing Address
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Address Line | 367 WILLIAMSON RD SUITE 103
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City | MOORESVILLE
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State | NC
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Zip | 28117-5944
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Country | US
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Telephone | 704-662-9111
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Fax | 704-662-9112
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONNA BARBAGLIA OLSEN
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Credential | DMD
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Telephone | 704-662-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1467
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License Number State | NC
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