Provider Demographics
NPI:1558357293
Name:DONNA B OLSEN DDA AND RICHARD A OLSEN DDS PA
Entity Type:Organization
Organization Name:DONNA B OLSEN DDA AND RICHARD A OLSEN DDS PA
Other - Org Name:OLSEN AND OLSEN GENERAL DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:BARBAGLIA
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-593-1090
Mailing Address - Street 1:8401 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-8797
Mailing Address - Country:US
Mailing Address - Phone:704-593-1090
Mailing Address - Fax:704-593-1092
Practice Address - Street 1:8401 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8797
Practice Address - Country:US
Practice Address - Phone:704-593-1090
Practice Address - Fax:704-593-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5940122400000X
NC5941122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Multi-Specialty