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NPI Code Detail

MEDICARE: DR. EARL A OLSON D.M.D.

MEDICARE: DR. EARL A OLSON D.M.D.
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 : 1568402063
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EARL A OLSON D.M.D.
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 :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 07/08/2007

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