MEDICARE: DR. CHAD OLSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D11141	MN

General Provider Information

NPI Number	:	1871716688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD OLSON DDS

Provider Business Mailing Address
First Line	:	16250 DULUTH AVE SE STE 200
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-2883
Country	:	US
Telephone Number	:	612-532-7828
Fax Number	:	952-447-4453

Provider Business Practice Location Address
First Line	:	16250 DULUTH AVE SE STE 200
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-2883
Country	:	US
Telephone Number	:	952-447-4463
Fax Number	:	952-447-4453

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	02/22/2024

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