Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 8805 | AZ |
Y | 1223E0200X | Endodontist | 102581 | CA |
NPI | 1073946927 |
---|---|
Provider Name | Dr. Christopher Boyd Olson |
First Address | Huntington Beach, CA 92648-3640 |
Second Address | Tempe, AZ 85282-5820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2013 |
Last Update Date | 20/02/2019 |