MEDICARE: DR. ANDREW CHARLES KEARSLEY OLSON D.D.S.

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	9286307	UT

General Provider Information

NPI Number	:	1780095463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW CHARLES KEARSLEY OLSON D.D.S.

Provider Business Mailing Address
First Line	:	2936 S HIGHLAND DR
Second Line	:	STE 200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3582
Country	:	US
Telephone Number	:	801-486-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2936 S HIGHLAND DR
Second Line	:	STE 200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3582
Country	:	US
Telephone Number	:	801-486-2800
Fax Number	:

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

Provider Enumeration Date	:	05/15/2014
Last Update Date	:	05/10/2022

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