Provider Demographics
NPI:1427124973
Name:MARTIN H OLESON DDS PC
Entity type:Organization
Organization Name:MARTIN H OLESON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:OLESON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-874-2230
Mailing Address - Street 1:PO BOX 559
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57226-0559
Mailing Address - Country:US
Mailing Address - Phone:605-874-2230
Mailing Address - Fax:605-874-2675
Practice Address - Street 1:210 SOUTH THIRD AVE.
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:SD
Practice Address - Zip Code:57226-0559
Practice Address - Country:US
Practice Address - Phone:605-874-2230
Practice Address - Fax:605-874-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM-5171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7802770Medicaid