Provider Demographics
NPI:1629177167
Name:OLSON, JEFFREY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
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 1:9901 VALLEY RANCH PKWY E
Mailing Address - Street 2:SUITE 1020 LB 28
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4730
Mailing Address - Country:US
Mailing Address - Phone:972-869-5966
Mailing Address - Fax:972-869-5972
Practice Address - Street 1:9901 VALLEY RANCH PKWY E
Practice Address - Street 2:SUITE 1020 LB 28
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4730
Practice Address - Country:US
Practice Address - Phone:972-869-5966
Practice Address - Fax:972-869-5972
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14231122300000X
CO7938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist