Provider Demographics
NPI:1427543784
Name:OLSEN, CHRISTOPHER STEVEN (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:STEVEN
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 1:6665 RICHARDSON HWY
Mailing Address - Street 2:
Mailing Address - City:SALCHA
Mailing Address - State:AK
Mailing Address - Zip Code:99714-9771
Mailing Address - Country:US
Mailing Address - Phone:801-580-6926
Mailing Address - Fax:
Practice Address - Street 1:203 S SANTA CLAUS LN STE A
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-7711
Practice Address - Country:US
Practice Address - Phone:907-488-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1026481223G0001X
AK1754291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty