Provider Demographics
NPI:1942324835
Name:OLSEN, RICHARD ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:OLSEN
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 1:367 WILLIAMSON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5944
Mailing Address - Country:US
Mailing Address - Phone:704-662-9111
Mailing Address - Fax:704-662-9112
Practice Address - Street 1:367 WILLIAMSON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5944
Practice Address - Country:US
Practice Address - Phone:704-662-9111
Practice Address - Fax:704-662-9112
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice