MEDICARE: DR. DAVID D OLSON DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	7017	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255306999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID D OLSON DDS, MS

Provider Business Mailing Address
First Line	:	10931 RAVEN RIDGE RD
Second Line	:	SUITE 105
City	:	RALEIGH
State	:	NC
Zip	:	27614-6499
Country	:	US
Telephone Number	:	919-845-8212
Fax Number	:	919-845-8201

Provider Business Practice Location Address
First Line	:	10931 RAVEN RIDGE RD
Second Line	:	SUITE 105
City	:	RALEIGH
State	:	NC
Zip	:	27614-6499
Country	:	US
Telephone Number	:	919-845-8212
Fax Number	:	919-845-8201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	07/09/2007

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