Provider Demographics
NPI:1023420320
Name:OLESEN, KIMBERLY (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:OLESEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:RYBICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:106 W SEEBOTH ST UNIT 911
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-4330
Mailing Address - Country:US
Mailing Address - Phone:262-497-5374
Mailing Address - Fax:
Practice Address - Street 1:106 W SEEBOTH ST UNIT 911
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-4330
Practice Address - Country:US
Practice Address - Phone:262-497-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7238 - 15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist