Provider Demographics
NPI:1275921561
Name:DOUG OLSON DMD PLLC
Entity Type:Organization
Organization Name:DOUG OLSON DMD PLLC
Other - Org Name:MY DENTAL COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:DOUG
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-527-2626
Mailing Address - Street 1:1610 E CHEYENNE MOUNTAIN BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4001
Mailing Address - Country:US
Mailing Address - Phone:719-527-2626
Mailing Address - Fax:719-527-3992
Practice Address - Street 1:1610 E CHEYENNE MOUNTAIN BLVD STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4001
Practice Address - Country:US
Practice Address - Phone:719-527-2626
Practice Address - Fax:719-527-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty