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General NPI Number Information
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NPI Number | 1740465244
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Entity Type | Organization
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Legal Business Name | OLSEN BROTHERS DENTAL P.L.L.C.
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 1840 E BASELINE RD STE A-2
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City | TEMPE
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State | AZ
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Zip | 85283-1527
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Country | US
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Telephone | 480-491-9911
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Fax | 480-491-9921
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Provider Business Mailing Address
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Address Line | 1840 E BASELINE RD STE A-2
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City | TEMPE
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State | AZ
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Zip | 85283-1527
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Country | US
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Telephone | 480-491-9911
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Fax | 480-491-9921
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BRIAN F OLSEN
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Credential | D.D.S.
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Telephone | 480-491-9911
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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 | 7390
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7393
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7230
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License Number State | AZ
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