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General NPI Number Information
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NPI Number | 1780059220
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Entity Type | Organization
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Legal Business Name | NILS W OLSON DDS PA
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 150 BAUGHMANS LN
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City | FREDERICK
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State | MD
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Zip | 21702-4004
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Country | US
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Telephone | 301-695-5454
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Fax | 301-695-3415
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Provider Business Mailing Address
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Address Line | 150 BAUGHMANS LN
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City | FREDERICK
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State | MD
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Zip | 21702-4004
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Country | US
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Telephone | 301-695-5454
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Fax | 301-695-3415
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Authorized Official
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Title or Position | OFFICE ADMINSTRATOR
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Name | MARY E RICE
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Credential |
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Telephone | 301-695-5454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 6439
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License Number State | MD
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