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

Table of content: (NPI 1033168885)

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".




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