Provider Demographics
NPI:1699829093
Name:OLSON, DAVID CLARENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CLARENCE
Last Name:OLSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 CROSSING STREET SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701
Mailing Address - Country:US
Mailing Address - Phone:701-852-4933
Mailing Address - Fax:701-852-0619
Practice Address - Street 1:3725 CROSSING STREET SW
Practice Address - Street 2:SUITE B
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701
Practice Address - Country:US
Practice Address - Phone:701-852-4933
Practice Address - Fax:701-852-0619
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1613122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40712Medicaid