Provider Demographics
NPI:1356477913
Name:OLESEN, SHELDON ARNOLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:ARNOLD
Last Name:OLESEN
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:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-0299
Mailing Address - Country:US
Mailing Address - Phone:715-349-2297
Mailing Address - Fax:715-349-2298
Practice Address - Street 1:24164 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872-0299
Practice Address - Country:US
Practice Address - Phone:715-349-2297
Practice Address - Fax:715-349-2298
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist