| NPI | 1205997152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZETTE A OLSON Dentist 320-632-8113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 11599) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-08-22 |