Provider Demographics
NPI:1770837643
Name:OLSON, JOSEPH MATTHEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MATTHEW
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 1:14 RUE DU PARC
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-3424
Mailing Address - Country:US
Mailing Address - Phone:702-533-5775
Mailing Address - Fax:
Practice Address - Street 1:7677 CENTER AVE STE 305
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9119
Practice Address - Country:US
Practice Address - Phone:714-847-8501
Practice Address - Fax:714-908-7715
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist