MEDICARE: DR. MARSHALL A OLSON 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	1223G0001X	General Practice Dentistry	23256	TX

General Provider Information

NPI Number	:	1851594386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARSHALL A OLSON DDS

Provider Business Mailing Address
First Line	:	777 BANDIT TRL
Second Line	:	SUITE A
City	:	KELLER
State	:	TX
Zip	:	76248-0111
Country	:	US
Telephone Number	:	817-427-2622
Fax Number	:	817-427-2625

Provider Business Practice Location Address
First Line	:	777 BANDIT TRL
Second Line	:	SUITE A
City	:	KELLER
State	:	TX
Zip	:	76248-0111
Country	:	US
Telephone Number	:	817-427-2622
Fax Number	:	817-427-2625

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

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	09/24/2013

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