Individual
GREGORY ALAN OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5509 EDEN PRAIRIE RD, MINNETONKA, MN 55345-5839
(952) 938-6038
(952) 935-9175
Mailing address
5509 EDEN PRAIRIE RD, MINNETONKA, MN 55345-5839
(952) 938-6038
(952) 935-9175
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10240
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
674718300
STATE MEDICAL ASSISTANCE#
MN
Enumeration date
07/12/2006
Last updated
10/21/2009
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