Provider Demographics
NPI:1114050432
Name:MITCHELL OLSON, DDS PA
Entity Type:Organization
Organization Name:MITCHELL OLSON, DDS PA
Other - Org Name:OLSON DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:BRENTON
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:952-884-1308
Mailing Address - Street 1:8400 LYNDALE AVE S STE 8
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2790
Mailing Address - Country:US
Mailing Address - Phone:952-884-1308
Mailing Address - Fax:952-884-3445
Practice Address - Street 1:8400 LYNDALE AVE S STE 8
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2790
Practice Address - Country:US
Practice Address - Phone:952-884-1308
Practice Address - Fax:952-884-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental