Provider Demographics
NPI:1871716688
Name:OLSON, CHAD (DDS)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16250 DULUTH AVE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2883
Mailing Address - Country:US
Mailing Address - Phone:612-532-7828
Mailing Address - Fax:952-447-4453
Practice Address - Street 1:16250 DULUTH AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-2883
Practice Address - Country:US
Practice Address - Phone:952-447-4463
Practice Address - Fax:952-447-4453
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND111411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice