Provider Demographics
NPI:1417074030
Name:OLSEN, MICHELLE CLAUDETTE (DDS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CLAUDETTE
Last Name:OLSEN
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 1:3351 EL CAMINO REAL
Mailing Address - Street 2:STE. 222
Mailing Address - City:ATHERTON
Mailing Address - State:CA
Mailing Address - Zip Code:94027
Mailing Address - Country:US
Mailing Address - Phone:650-361-0180
Mailing Address - Fax:650-361-0113
Practice Address - Street 1:3351 EL CAMINO REAL
Practice Address - Street 2:STE. 222
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027
Practice Address - Country:US
Practice Address - Phone:650-361-0180
Practice Address - Fax:650-361-0113
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics