Provider Demographics
NPI:1649420126
Name:OLSON, KATHERINE E (DDS, MS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:OLSON
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6755 PHELAN BLVD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6075
Mailing Address - Country:US
Mailing Address - Phone:409-866-4600
Mailing Address - Fax:409-866-4607
Practice Address - Street 1:6755 PHELAN BLVD
Practice Address - Street 2:SUITE 18
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6075
Practice Address - Country:US
Practice Address - Phone:409-866-4600
Practice Address - Fax:409-866-4607
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics