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Provider Information for 1407902950

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. KELLY J. OLSEN D.D.S.

Gender: MALE

Individual NPI: 1407902950

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1407902950
Enumeration Date 2007-01-26
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 321 N MALL DR SUITE #D101
ST GEORGE, UT 84790-7302
United States

Phone: 435-628-5496 | Fax: 435-628-6285
View Map External Link
Primary Practice Address 321 N MALL DR SUITE #D101
ST GEORGE, UT 84790-7302
United States

Phone: 435-628-5496 | Fax: 435-628-6285
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice UT 309573