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General NPI Number Information
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NPI Number | 1144527359
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Entity Type | Individual
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Provider Name | GREGORY D OLSEN D.D.S., M.S.D.
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Gender | Male
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 4232 E CHANDLER BLVD STE 10
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City | PHOENIX
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State | AZ
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Zip | 85048-8879
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Country | US
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Telephone | 480-759-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 18493 E WALNUT RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-3551
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D009782
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License Number State | AZ
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