Provider Demographics
NPI:1578337705
Name:OLSEN DENTAL PC
Entity Type:Organization
Organization Name:OLSEN DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-728-2840
Mailing Address - Street 1:715 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6808
Mailing Address - Country:US
Mailing Address - Phone:406-728-2840
Mailing Address - Fax:406-728-3083
Practice Address - Street 1:715 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6808
Practice Address - Country:US
Practice Address - Phone:406-728-2840
Practice Address - Fax:406-728-3083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLSEN DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty