Provider Demographics
NPI:1134803208
Name:CHRISTOPHER OLSEN, DDS LLC
Entity type:Organization
Organization Name:CHRISTOPHER OLSEN, DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-488-1515
Mailing Address - Street 1:203 S SANTA CLAUS LN
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-7711
Mailing Address - Country:US
Mailing Address - Phone:907-488-1515
Mailing Address - Fax:907-488-1516
Practice Address - Street 1:203 S SANTA CLAUS LN
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-7711
Practice Address - Country:US
Practice Address - Phone:907-488-1515
Practice Address - Fax:907-488-1516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTOPHER OLSEN, DDS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty