Provider Demographics
NPI:1336232685
Name:OLSON, GARY DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DOUGLAS
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 1:157 W. CEDAR ST.
Mailing Address - Street 2:SUITE 206
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2563
Mailing Address - Country:US
Mailing Address - Phone:330-253-8711
Mailing Address - Fax:330-253-8711
Practice Address - Street 1:157 W CEDAR ST
Practice Address - Street 2:SUITE 206
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2564
Practice Address - Country:US
Practice Address - Phone:330-253-8711
Practice Address - Fax:330-253-8711
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0164671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice