Individual
BROCK L OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
621 N 8TH ST W, RIVERTON, WY 82501-3318
(307) 856-9725
(307) 856-7075
Mailing address
621 N 8TH ST W, RIVERTON, WY 82501-3318
(307) 856-9725
(307) 856-7075
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1284
WY
Other
Enumeration date
07/11/2011
Last updated
07/11/2011
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