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General NPI Number Information
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NPI Number | 1770837643
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Entity Type | Individual
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Provider Name | JOSEPH MATTHEW OLSON DMD
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Gender | Male
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Dates
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Enumeration Date | 10/31/2012
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Last Update Date | 12/20/2021
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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 |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 63843
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License Number State | CA
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