Provider Demographics
NPI:1023213998
Name:DONNA B OLSEN DDS & RICHARD A OLSEN DDS, PA
Entity Type:Organization
Organization Name:DONNA B OLSEN DDS & RICHARD A OLSEN DDS, PA
Other - Org Name:OLSEN GENERAL DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:BARBAGLIA
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-662-9111
Mailing Address - Street 1:367 WILLIAMSON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5944
Mailing Address - Country:US
Mailing Address - Phone:704-662-9111
Mailing Address - Fax:704-662-9112
Practice Address - Street 1:367 WILLIAMSON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5944
Practice Address - Country:US
Practice Address - Phone:704-662-9111
Practice Address - Fax:704-662-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty