Provider Demographics
NPI:1265659585
Name:OLSEN, THOMAS W (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
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 1:550 E TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-2894
Mailing Address - Country:US
Mailing Address - Phone:715-369-1950
Mailing Address - Fax:715-369-1879
Practice Address - Street 1:550 E TIMBER DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2894
Practice Address - Country:US
Practice Address - Phone:715-369-1950
Practice Address - Fax:715-369-1879
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI400-19191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery