Provider Demographics
NPI:1740396571
Name:OLSON, SUZETTE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUZETTE
Middle Name:A
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 1:74 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3042
Mailing Address - Country:US
Mailing Address - Phone:320-632-8113
Mailing Address - Fax:320-632-5584
Practice Address - Street 1:74 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3042
Practice Address - Country:US
Practice Address - Phone:320-632-8113
Practice Address - Fax:320-632-5584
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice