Provider Demographics
NPI:1396188330
Name:OLSON, JENNETTE RUSH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNETTE
Middle Name:RUSH
Last Name:OLSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 E BAILEY BOSWELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76131-3569
Mailing Address - Country:US
Mailing Address - Phone:817-234-9378
Mailing Address - Fax:
Practice Address - Street 1:608 E BAILEY BOSWELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-3569
Practice Address - Country:US
Practice Address - Phone:817-234-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18094122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist