Provider Demographics
NPI:1508905423
Name:OLSON ROMMESMO, LYNNE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:MARIE
Last Name:OLSON ROMMESMO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 19TH AVE N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2201
Mailing Address - Country:US
Mailing Address - Phone:701-293-8625
Mailing Address - Fax:
Practice Address - Street 1:1115 19TH AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2201
Practice Address - Country:US
Practice Address - Phone:701-293-8625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40902Medicaid