Provider Demographics
NPI:1407950744
Name:OLSON, LAWRENCE JOHN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOHN
Last Name:OLSON
Suffix:JR
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 1:6801 NW 39TH EXPRESSWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-2501
Mailing Address - Country:US
Mailing Address - Phone:405-787-1946
Mailing Address - Fax:405-495-0344
Practice Address - Street 1:6801 NW 39TH EXPRESSWAY
Practice Address - Street 2:SUITE A
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2501
Practice Address - Country:US
Practice Address - Phone:405-787-1946
Practice Address - Fax:405-495-0344
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist