Provider Demographics
NPI:1285945568
Name:OLSON, NATHAN DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:DANIEL
Last Name:OLSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLEVELAND ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5614
Mailing Address - Country:US
Mailing Address - Phone:563-263-8821
Mailing Address - Fax:563-263-8827
Practice Address - Street 1:200 CLEVELAND ST
Practice Address - Street 2:SUITE F
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5614
Practice Address - Country:US
Practice Address - Phone:563-263-8821
Practice Address - Fax:563-263-8827
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice