Provider Demographics
NPI:1275873374
Name:OLSEN, F KRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:F
Middle Name:KRIS
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 1:1320 S GREEN BAY ROAD
Mailing Address - Street 2:RACINE DENTAL GROUP
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406
Mailing Address - Country:US
Mailing Address - Phone:262-637-9371
Mailing Address - Fax:262-637-3071
Practice Address - Street 1:1320 S GREEN BAY ROAD
Practice Address - Street 2:RACINE DENTAL GROUP
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406
Practice Address - Country:US
Practice Address - Phone:262-637-9371
Practice Address - Fax:262-637-3071
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics