Provider Demographics
NPI:1043813256
Name:PATEL-OLSEN SUB-DSO LLC
Entity type:Organization
Organization Name:PATEL-OLSEN SUB-DSO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAUGHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-437-7070
Mailing Address - Street 1:9920 COULOAK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-8923
Mailing Address - Country:US
Mailing Address - Phone:704-392-7676
Mailing Address - Fax:
Practice Address - Street 1:218 BURKEMONT AVE
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4454
Practice Address - Country:US
Practice Address - Phone:828-437-7070
Practice Address - Fax:828-437-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty