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General NPI Number Information
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NPI Number | 1801105937
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Entity Type | Organization
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Legal Business Name | WEST END DENTAL GROUP, PLLC
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 6830 PHELAN BLVD
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City | BEAUMONT
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State | TX
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Zip | 77706-5970
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Country | US
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Telephone | 409-860-9600
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Fax | 409-860-1704
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Provider Business Mailing Address
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Address Line | 6830 PHELAN BLVD
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City | BEAUMONT
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State | TX
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Zip | 77706-5970
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Country | US
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Telephone | 409-860-9600
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Fax | 409-860-1704
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID O OLSON
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Credential | DDS,FICD,FACD
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Telephone | 409-860-9600
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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 | 21519
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License Number State | TX
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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 | 8553
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License Number State | TX
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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 | 10154
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License Number State | TX
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