MEDICARE: MARK OLSEN DDS

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	122300000X	Dentist	5501015	WI

General Provider Information

NPI Number	:	1730353277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK OLSEN DDS

Provider Business Mailing Address
First Line	:	2630 IRONWOOD DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-8830
Country	:	US
Telephone Number	:	608-837-7842
Fax Number	:	608-318-8787

Provider Business Practice Location Address
First Line	:	2630 IRONWOOD DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-8830
Country	:	US
Telephone Number	:	608-837-7842
Fax Number	:	608-318-8787

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

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	06/26/2025

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