| NPI | 1740215656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY ALAN OLSON Dentist 952-938-6038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN D11282/D10240) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2009-10-21 |