Provider Demographics
NPI:1457406225
Name:OLSON, MATTHEW KARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:KARL
Last Name:OLSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MOTT AVE
Mailing Address - Street 2:3C
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3320
Mailing Address - Country:US
Mailing Address - Phone:203-838-3132
Mailing Address - Fax:203-854-5726
Practice Address - Street 1:10 MOTT AVE
Practice Address - Street 2:3C
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3320
Practice Address - Country:US
Practice Address - Phone:203-838-3132
Practice Address - Fax:203-854-5726
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT95001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice