Provider Demographics
NPI:1083678262
Name:OLSON, ERIC M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:OLSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2078 ROGERO RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-4119
Mailing Address - Country:US
Mailing Address - Phone:904-743-9222
Mailing Address - Fax:904-745-4004
Practice Address - Street 1:2894 S 8TH ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4462
Practice Address - Country:US
Practice Address - Phone:904-261-0022
Practice Address - Fax:904-261-6289
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96891223P0700X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL629935OtherUNITED CONCORDIA PROVIDER
FL67256OtherBCBS PROVIDER