Individual
GARY R. OLSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6907 S WENTWORTH AVE, CHICAGO, IL 60621-3734
(773) 488-5300
Mailing address
1319 W WESTGATE TER, CHICAGO, IL 60607-3304
(773) 488-5300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IN
Other
Enumeration date
10/19/2005
Last updated
07/08/2007
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