Provider Demographics
NPI:1821162595
Name:OLSON, DANIEL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
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 1:2510 NW MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470
Mailing Address - Country:US
Mailing Address - Phone:541-673-4152
Mailing Address - Fax:541-673-4156
Practice Address - Street 1:2510 NW MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470
Practice Address - Country:US
Practice Address - Phone:541-673-4152
Practice Address - Fax:541-673-4156
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7394204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
133665Medicare ID - Type UnspecifiedGRP
T08402Medicare UPIN
133666Medicare ID - Type UnspecifiedINDIV