Provider Demographics
NPI:1851415160
Name:OLSON, JAMES A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
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 1:2300 DURANT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1607
Mailing Address - Country:US
Mailing Address - Phone:510-848-4732
Mailing Address - Fax:510-848-4846
Practice Address - Street 1:2300 DURANT AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1607
Practice Address - Country:US
Practice Address - Phone:510-848-4732
Practice Address - Fax:510-848-4846
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA229101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-288847OtherTIN