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General NPI Number Information
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NPI Number | 1184936403
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Entity Type | Organization
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Legal Business Name | OLSEN & OLSEN PLLC
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Dates
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Enumeration Date | 07/02/2010
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Last Update Date | 07/02/2010
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Provider Practice Location Address
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Address Line | 10564 S US HIGHWAY 15 501 SUITE D
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-5167
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Country | US
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Telephone | 910-246-3232
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Fax |
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Provider Business Mailing Address
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Address Line | 10564 S US HIGHWAY 15 501 SUITE D
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-5167
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Country | US
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Telephone | 910-246-3232
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Fax |
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Authorized Official
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Title or Position | CO-MANAGER
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Name | DR. JUSTIN T OLSEN
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Credential | DDS, MS
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Telephone | 910-246-3232
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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 | 8178
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8177
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License Number State | NC
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