Provider Demographics
NPI:1669891289
Name:OLSEN & OLSEN, I, PA
Entity type:Organization
Organization Name:OLSEN & OLSEN, I, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-246-3232
Mailing Address - Street 1:10564 S US HIGHWAY 15 501
Mailing Address - Street 2:SUITE D
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5167
Mailing Address - Country:US
Mailing Address - Phone:910-246-3232
Mailing Address - Fax:
Practice Address - Street 1:1524 NC HIGHWAY 87 SOUTH
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326
Practice Address - Country:US
Practice Address - Phone:910-246-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8177261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental