Individual
BRANT N OLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.,P.A.
Contact information
Practice address
250 S SKYLINE DR, SUITE 5, IDAHO FALLS, ID 83402-3292
(208) 522-9101
(208) 522-2517
Mailing address
250 S SKYLINE DR, SUITE 5, IDAHO FALLS, ID 83402-3292
(208) 522-9101
(208) 522-2517
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3386
ID
Other
Enumeration date
07/19/2006
Last updated
07/08/2007
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