Provider Demographics
NPI:1003445230
Name:OLSEN, KENT (DPM)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:OLSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N ZANG BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4858
Mailing Address - Country:US
Mailing Address - Phone:972-254-0680
Mailing Address - Fax:972-254-0683
Practice Address - Street 1:2001 N MACARTHUR BLVD STE 300
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2253
Practice Address - Country:US
Practice Address - Phone:972-254-0680
Practice Address - Fax:972-254-0683
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX692062213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery