Provider Demographics
NPI:1972945079
Name:OLSON, KYLE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:R
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 1:1903 EP TRUE PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-7000
Mailing Address - Country:US
Mailing Address - Phone:515-224-1618
Mailing Address - Fax:
Practice Address - Street 1:1903 E P TRUE PKWY
Practice Address - Street 2:301
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-7000
Practice Address - Country:US
Practice Address - Phone:515-224-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice