Olsen, Wayne L.

Olsen, Wayne L. is an individual health care provider with primary practice located at 12776 S West Bay Shore Dr , Traverse City MI 49684-5451. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Olsen, Wayne L. can be contacted via phone (231) 946-3512.

Contact Information

Primary practice address
12776 S West Bay Shore Dr Traverse City MI 49684-5451
Fax: (231) 946-1908
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 2901018277 Michigan

Profile Details

NPI number 1215984216
LBN Legal business name Olsen, Wayne L.
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date May 27th, 2006
Last updated Dec 27th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215984216 NPPES
Michigan MEDICAID 4373146
Michigan MEDICAID 4370725
Michigan Other 1003095605

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