| NPI | 1013078955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK D OLSEN Dentist 608-837-7842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WI 5501015) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 5001799) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-08-22 |