1033168885 NPI number — DAVID L. OLSON, DMD, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033168885 NPI number — DAVID L. OLSON, DMD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID L. OLSON, DMD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033168885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1460
Provider Second Line Business Mailing Address:
100 BERKELEY SQUARE LANE
Provider Business Mailing Address City Name:
GOOSE CREEK
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29445-1460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-553-5231
Provider Business Mailing Address Fax Number:
843-797-7547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BERKELEY SQUARE LN
Provider Second Line Business Practice Location Address:
POB 1460
Provider Business Practice Location Address City Name:
GOOSE CREEK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29445-2958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-553-5231
Provider Business Practice Location Address Fax Number:
843-797-7547
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLSON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
843-553-5231

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  1763 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 454338 . This is a "UNITED CONCORDIA INSURANC" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com