Provider Demographics
NPI:1750445045
Name:OLSON, BRIAN D (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:OLSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 DAVIS RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2499
Mailing Address - Country:US
Mailing Address - Phone:706-364-7664
Mailing Address - Fax:706-364-6674
Practice Address - Street 1:233 DAVIS RD
Practice Address - Street 2:SUITE E
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2499
Practice Address - Country:US
Practice Address - Phone:706-364-7664
Practice Address - Fax:706-364-6674
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0114871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics