Individual
TAD OLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1130 S COUNTRY CLUB DR, MESA, AZ 85210-4639
(480) 461-9866
Mailing address
1293 S 480 W, SALEM, UT 84653-9108
(801) 420-1933
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D009695
AZ
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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