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General NPI Number Information
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NPI Number | 1033168885
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Entity Type | Organization
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Legal Business Name | DAVID L. OLSON, DMD, PA
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 BERKELEY SQUARE LN POB 1460
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City | GOOSE CREEK
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State | SC
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Zip | 29445-2958
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Country | US
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Telephone | 843-553-5231
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Fax | 843-797-7547
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Provider Business Mailing Address
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Address Line | PO BOX 1460 100 BERKELEY SQUARE LANE
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City | GOOSE CREEK
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State | SC
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Zip | 29445-1460
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Country | US
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Telephone | 843-553-5231
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Fax | 843-797-7547
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID LEE OLSON
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Credential | DMD
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Telephone | 843-553-5231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1763
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License Number State | SC
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