Organization
PEDIATRIC DENTISTRY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRAVIS L. OLSON DDS (PRESIDENT)
(701) 293-6999
Entity
Organization
Contact information
Practice address
1205 16TH AVE. SOUTH, FARGO, ND 58103
(701) 293-6999
(701) 235-2297
Mailing address
1205 16TH AVE. SOUTH, FARGO, ND 58103
(701) 293-6999
(701) 235-2297
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2032
ND
Other
Enumeration date
06/25/2009
Last updated
06/25/2009
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