# PEDIATRIC DENTISTRY LTD

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487882718
- **Authorized official:** DR. TRAVIS L. OLSON DDS (PRESIDENT)
- **Authorized official phone:** (701) 293-6999

## Contact information

- **Practice address:** 1205 16TH AVE. SOUTH, FARGO, ND 58103
- **Practice address phone:** (701) 293-6999
- **Practice address fax:** (701) 235-2297
- **Mailing address:** 1205 16TH AVE. SOUTH, FARGO, ND 58103
- **Mailing address phone:** (701) 293-6999
- **Mailing address fax:** (701) 235-2297

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2032 | ND | Yes |

## Other

- **Enumeration date:** 06/25/2009
- **Last updated:** 06/25/2009