| NPI | 1225104458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY J OLSON Co Owner 952-435-0355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D11326) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2020-08-22 |