Provider Demographics
NPI:1497889075
Name:OLSON, NILS (DDS)
Entity Type:Individual
Prefix:DR
First Name:NILS
Middle Name:
Last Name:OLSON
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 1:150 BAUGHMANS LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4004
Mailing Address - Country:US
Mailing Address - Phone:301-695-5454
Mailing Address - Fax:301-695-3415
Practice Address - Street 1:150 BAUGHMANS LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4004
Practice Address - Country:US
Practice Address - Phone:301-695-5454
Practice Address - Fax:301-695-3415
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD64391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6439OtherDENTIST LICENSE NUMBER