| NPI | 1801105937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID O OLSON Dentist 409-860-9600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 10154) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21519) |
| 1223G0001X Dentist, General Practice (Licence: TX 8553) | |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2012-02-07 |