Provider Demographics
NPI:1386805141
Name:OLAFSEN, MEL HERBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:MEL
Middle Name:HERBERT
Last Name:OLAFSEN
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 1:3444 KEARNY VILLA RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1959
Mailing Address - Country:US
Mailing Address - Phone:858-278-4500
Mailing Address - Fax:858-278-5071
Practice Address - Street 1:3444 KEARNY VILLA RD
Practice Address - Street 2:SUITE 406
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1959
Practice Address - Country:US
Practice Address - Phone:858-278-4500
Practice Address - Fax:858-278-5071
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice