Provider Demographics
NPI:1639243314
Name:OLSON, DENNIS R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
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 1:2101 WOODWINDS DR
Mailing Address - Street 2:SUITE #500
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2525
Mailing Address - Country:US
Mailing Address - Phone:651-209-0270
Mailing Address - Fax:651-209-0272
Practice Address - Street 1:2101 WOODWINDS DR
Practice Address - Street 2:SUITE #500
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2525
Practice Address - Country:US
Practice Address - Phone:651-209-0270
Practice Address - Fax:651-209-0272
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN71611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice