Provider Demographics
NPI:1205064359
Name:HEATHER J. OLSON, D.M.D., P.A.
Entity type:Organization
Organization Name:HEATHER J. OLSON, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-886-5255
Mailing Address - Street 1:204 TOWN BANK RD
Mailing Address - Street 2:
Mailing Address - City:N CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-2942
Mailing Address - Country:US
Mailing Address - Phone:609-886-5255
Mailing Address - Fax:609-886-7051
Practice Address - Street 1:204 TOWN BANK RD
Practice Address - Street 2:
Practice Address - City:N CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-2942
Practice Address - Country:US
Practice Address - Phone:609-886-5255
Practice Address - Fax:609-886-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D-1022789021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty