Provider Demographics
NPI:1609974724
Name:OLSON, SUSAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:OLSON
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 1:1797 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2043
Mailing Address - Country:US
Mailing Address - Phone:651-698-6716
Mailing Address - Fax:
Practice Address - Street 1:1121 TOWN CENTRE DR STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1217
Practice Address - Country:US
Practice Address - Phone:651-454-4771
Practice Address - Fax:651-406-9298
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice