Individual
GRANT OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3424 S CULPEPPER CT, SPRINGFIELD, MO 65804-3755
(417) 343-1266
Mailing address
3424 S CULPEPPER CT, SPRINGFIELD, MO 65804-3755
(417) 343-1266
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2011016216
MO
Other
Enumeration date
06/15/2011
Last updated
10/02/2012
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