Provider Demographics
NPI:1144245697
Name:OLSEN, MARC ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ERIC
Last Name:OLSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7102
Mailing Address - Country:US
Mailing Address - Phone:406-652-4020
Mailing Address - Fax:406-652-1776
Practice Address - Street 1:2370 AVENUE C
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7102
Practice Address - Country:US
Practice Address - Phone:406-652-4020
Practice Address - Fax:406-652-1776
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics