Provider Demographics
NPI:1538188255
Name:OLSON, ROBERT P (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
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 1:122 AVILA RD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2816
Mailing Address - Country:US
Mailing Address - Phone:650-341-2403
Mailing Address - Fax:
Practice Address - Street 1:36 N SAN MATEO DR
Practice Address - Street 2:SUITE B
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4522
Practice Address - Country:US
Practice Address - Phone:650-342-0474
Practice Address - Fax:650-558-0967
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice