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General NPI Number Information
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NPI Number | 1083718605
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Entity Type | Organization
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Legal Business Name | TOMHAVE OLSON DENTAL ASSOCIATES
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 510 CUMBERLAND ST. EXECUTIVE PLAZA, 4TH FLOOR
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City | BRISTOL
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State | VA
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Zip | 24201
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Country | US
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Telephone | 218-879-4541
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 STANLEY AVENUE
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City | CLOQUET
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State | MN
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Zip | 55720
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Country | US
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Telephone | 218-879-4541
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Fax | 218-879-4542
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES TOMHAVE
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Credential | DDS
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Telephone | 218-879-4541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D9802
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D9213
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D10799
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License Number State | MN
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