Provider Demographics
NPI:1063963049
Name:OLSEN, BROOKE MILLER (DDS)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:MILLER
Last Name:OLSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:RAE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:818 18TH ST NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-3513
Mailing Address - Country:US
Mailing Address - Phone:202-659-9100
Mailing Address - Fax:
Practice Address - Street 1:818 18TH ST NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3513
Practice Address - Country:US
Practice Address - Phone:202-659-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10016281223G0001X
DCDEN10016281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice