Provider Demographics
NPI:1578634358
Name:OLSEN, EDWARD ARTHUR (EDWARD OLSEN)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ARTHUR
Last Name:OLSEN
Suffix:
Gender:M
Credentials:EDWARD OLSEN
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDWARD OLSEN
Mailing Address - Street 1:50 MONMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1614
Mailing Address - Country:US
Mailing Address - Phone:732-842-7333
Mailing Address - Fax:732-758-8118
Practice Address - Street 1:50 MONMOUTH ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1614
Practice Address - Country:US
Practice Address - Phone:732-842-7333
Practice Address - Fax:732-758-8118
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01058600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist