Provider Demographics
NPI:1891888061
Name:OLSON, WAYNE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:D
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 1:1008 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301
Mailing Address - Country:US
Mailing Address - Phone:636-723-2085
Mailing Address - Fax:
Practice Address - Street 1:1008 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303
Practice Address - Country:US
Practice Address - Phone:636-946-9949
Practice Address - Fax:636-946-3915
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL113871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice