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General NPI Number Information
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NPI Number | 1194106823
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER L. OLSEN, DDS PLLC
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 717 S STATE ST SUITE #2
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City | FAIRMONT
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State | MN
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Zip | 56031-4469
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Country | US
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Telephone | 507-235-5985
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Fax |
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Provider Business Mailing Address
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Address Line | 717 S STATE ST. STE #2
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City | FAIRMONT
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State | MN
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Zip | 56031
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Country | US
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Telephone | 507-235-5985
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Fax | 507-235-5125
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Authorized Official
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Title or Position | DENTIST
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Name | MR. CHRISTOPHER LEE OLSEN
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Credential | DDS
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Telephone | 507-235-5985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9502
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License Number State | MN
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