Provider Demographics
NPI:1255306999
Name:OLSON, DAVID D (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:OLSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10931 RAVEN RIDGE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6499
Mailing Address - Country:US
Mailing Address - Phone:919-845-8212
Mailing Address - Fax:919-845-8201
Practice Address - Street 1:10931 RAVEN RIDGE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6499
Practice Address - Country:US
Practice Address - Phone:919-845-8212
Practice Address - Fax:919-845-8201
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990282Medicaid