Provider Demographics
NPI:1780059220
Name:NILS W OLSON DDS PA
Entity type:Organization
Organization Name:NILS W OLSON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-695-5454
Mailing Address - Street 1:150 BAUGHMANS LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4004
Mailing Address - Country:US
Mailing Address - Phone:301-695-5454
Mailing Address - Fax:301-695-3415
Practice Address - Street 1:150 BAUGHMANS LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4004
Practice Address - Country:US
Practice Address - Phone:301-695-5454
Practice Address - Fax:301-695-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6439261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental