Provider Demographics
NPI:1083718605
Name:TOMHAVE OLSON DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:TOMHAVE OLSON DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMHAVE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-879-4541
Mailing Address - Street 1:1211 STANLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720
Mailing Address - Country:US
Mailing Address - Phone:218-879-4541
Mailing Address - Fax:218-879-4542
Practice Address - Street 1:510 CUMBERLAND ST.
Practice Address - Street 2:EXECUTIVE PLAZA, 4TH FLOOR
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201
Practice Address - Country:US
Practice Address - Phone:218-879-4541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND9802122300000X
MND9213122300000X
MND10799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty