Provider Demographics
NPI:1205041498
Name:OLSON, JEFFREY J (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:OLSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E NICOLLET BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6734
Mailing Address - Country:US
Mailing Address - Phone:952-435-0355
Mailing Address - Fax:952-435-0322
Practice Address - Street 1:625 E NICOLLET BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6734
Practice Address - Country:US
Practice Address - Phone:952-435-0355
Practice Address - Fax:952-435-0322
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND113261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice