Provider Demographics
NPI:1326350547
Name:OLSEN, JORDAN LANDON (DDS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LANDON
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 1:7535 CARPENTER FIRE STATION RD STE 201-A
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8617
Mailing Address - Country:US
Mailing Address - Phone:919-360-9825
Mailing Address - Fax:
Practice Address - Street 1:7535 CARPENTER FIRE STATION RD STE 201-A
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8617
Practice Address - Country:US
Practice Address - Phone:919-360-9825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist