Provider Demographics
NPI:1083772123
Name:OLSON, BRADLEY J (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
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 1:3450 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602
Mailing Address - Country:US
Mailing Address - Phone:301-645-6611
Mailing Address - Fax:301-843-3069
Practice Address - Street 1:3450 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602
Practice Address - Country:US
Practice Address - Phone:301-645-6611
Practice Address - Fax:301-843-3069
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD83911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice