Provider Demographics
NPI:1497176572
Name:OLSON, DAVID ERIC (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
Last Name:OLSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 CHEROKEE ST NW
Mailing Address - Street 2:SUITE 117
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2027
Mailing Address - Country:US
Mailing Address - Phone:770-424-8077
Mailing Address - Fax:770-499-1929
Practice Address - Street 1:3600 CHEROKEE ST NW
Practice Address - Street 2:SUITE 117
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2027
Practice Address - Country:US
Practice Address - Phone:770-424-8077
Practice Address - Fax:770-499-1929
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0102331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice