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NPI Code Detail

MEDICARE: EARL A. OLSON, DMD, PLC

MEDICARE: EARL A. OLSON, DMD, PLC
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
11223G0001XGeneral Practice Dentistry736VT

General Provider Information

NPI Number : 1528183373
Entity Type Code : Organization
Provider Name (Legal Business Name) : EARL A. OLSON, DMD, PLC
Provider Business Mailing Address
First Line : 163 STRATTON RD
Second Line :
City : RUTLAND
State : VT
Zip : 05701-4619
Country : US
Telephone Number : 802-773-0478
Fax Number :
Provider Business Practice Location Address
First Line : 163 STRATTON RD
Second Line :
City : RUTLAND
State : VT
Zip : 05701-4619
Country : US
Telephone Number : 802-773-0478
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. EARL A. OLSON
Credential : D.M.D
Telephone Number : 802-773-0478
Provider Enumeration Date : 03/20/2007
Last Update Date : 08/22/2020

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