Provider Demographics
NPI:1659449023
Name:JCOLSON DDS INC
Entity type:Organization
Organization Name:JCOLSON DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-875-8555
Mailing Address - Street 1:161 WAILEA IKE PL
Mailing Address - Street 2:SUITE B104
Mailing Address - City:WAILEA
Mailing Address - State:HI
Mailing Address - Zip Code:96753-6521
Mailing Address - Country:US
Mailing Address - Phone:808-875-8555
Mailing Address - Fax:
Practice Address - Street 1:161 WAILEA IKE PL
Practice Address - Street 2:SUITE B104
Practice Address - City:WAILEA
Practice Address - State:HI
Practice Address - Zip Code:96753-6521
Practice Address - Country:US
Practice Address - Phone:808-875-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2487261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental