Organization
OLSON DENTAL ASSOCIATES P.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH M OLSON D.D.S. (OWNER)
(651) 788-7045
Entity
Organization
Contact information
Practice address
393 DUNLAP ST N, SUITE 308, SAINT PAUL, MN 55104-4200
(651) 788-7045
Mailing address
393 DUNLAP ST N, SUITE 308, SAINT PAUL, MN 55104-4200
(651) 788-7045
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
8085
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235322504
—
MN
Enumeration date
01/28/2010
Last updated
01/28/2010
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