Provider Demographics
NPI:1255596045
Name:OLSON, ANN MARIE
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11671 JOLLYVILLE RD # 204A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4139
Mailing Address - Country:US
Mailing Address - Phone:512-345-9973
Mailing Address - Fax:512-345-9664
Practice Address - Street 1:11671 JOLLYVILLE RD # 204A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4139
Practice Address - Country:US
Practice Address - Phone:512-345-9973
Practice Address - Fax:512-345-9664
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15655122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist