Provider Demographics
NPI:1306284609
Name:MARSHALL OLSON DDS PLLC
Entity type:Organization
Organization Name:MARSHALL OLSON DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-427-2622
Mailing Address - Street 1:777 BANDIT TRL
Mailing Address - Street 2:SUITE A
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-0111
Mailing Address - Country:US
Mailing Address - Phone:817-427-2622
Mailing Address - Fax:817-427-2625
Practice Address - Street 1:777 BANDIT TRL
Practice Address - Street 2:SUITE A
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-0111
Practice Address - Country:US
Practice Address - Phone:817-427-2622
Practice Address - Fax:817-427-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty