MEDICARE: JOHN A OLSEN, DDS, SC

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	1223G0001X	General Practice Dentistry	4257	WI

General Provider Information

NPI Number	:	1528188356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN A OLSEN, DDS, SC

Provider Business Mailing Address
First Line	:	9725 W SAINT MARTINS RD
Second Line	:
City	:	FRANKLIN
State	:	WI
Zip	:	53132-9624
Country	:	US
Telephone Number	:	414-425-7050
Fax Number	:	414-425-8970

Provider Business Practice Location Address
First Line	:	9725 W SAINT MARTINS RD
Second Line	:
City	:	FRANKLIN
State	:	WI
Zip	:	53132-9624
Country	:	US
Telephone Number	:	414-425-7050
Fax Number	:	414-425-8970

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	MRS. GINA M PAEGELOW
Credential	:
Telephone Number	:	414-425-7050

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/22/2020

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