| NPI | 1235322504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH MICHAEL OLSON Owner 651-788-7045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN 8085) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2007-08-21 |