Provider Demographics
NPI:1528188356
Name:JOHN A OLSEN, DDS, SC
Entity Type:Organization
Organization Name:JOHN A OLSEN, DDS, SC
Other - Org Name:FRANKLIN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAEGELOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-425-7050
Mailing Address - Street 1:9725 W SAINT MARTINS RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9624
Mailing Address - Country:US
Mailing Address - Phone:414-425-7050
Mailing Address - Fax:414-425-8970
Practice Address - Street 1:9725 W SAINT MARTINS RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9624
Practice Address - Country:US
Practice Address - Phone:414-425-7050
Practice Address - Fax:414-425-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty