Individual
ROBERT OLSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8119 USTICK RD, BOISE, ID 83704-5754
(208) 376-3600
Mailing address
8119 USTICK RD, BOISE, ID 83704-5754
(208) 376-3600
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
D-3040-EN
ID
Other
Enumeration date
05/12/2008
Last updated
05/12/2008
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