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General NPI Number Information
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NPI Number | 1679244883
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Entity Type | Organization
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Legal Business Name | OLSON DENTAL CORPORATION
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 7677 CENTER AVE STE 305
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-9119
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Country | US
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Telephone | 714-847-8501
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Fax | 714-908-7715
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Provider Business Mailing Address
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Address Line | 14 RUE DU PARC
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City | FOOTHILL RANCH
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State | CA
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Zip | 92610-3424
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Country | US
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Telephone | 702-533-5775
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JOSEPH M OLSON
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Credential | DMD
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Telephone | 702-533-5775
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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 |
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License Number State |
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