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General NPI Number Information
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NPI Number | 1881310266
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Entity Type | Individual
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Provider Name | ROBERT WAYNE OLSEN DMD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 34 BRUYER WAY
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City | KALISPELL
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State | MT
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Zip | 59901-6305
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Country | US
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Telephone | 503-884-7906
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Fax |
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Provider Business Mailing Address
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Address Line | 94012 RANGE ROAD 215
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City | LETHBRIDGE COUNTY
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State | ALBERTA
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Zip | T1J 5R4
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Country | CA
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Telephone |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 23787
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License Number State | MT
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