Provider Demographics
NPI:1962158881
Name:OLSON, GEORGIA D (RDH)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:D
Last Name:OLSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S SCHNELL DR
Mailing Address - Street 2:
Mailing Address - City:OXBOW
Mailing Address - State:ND
Mailing Address - Zip Code:58047-7204
Mailing Address - Country:US
Mailing Address - Phone:701-799-3574
Mailing Address - Fax:
Practice Address - Street 1:213 S SCHNELL DR
Practice Address - Street 2:
Practice Address - City:OXBOW
Practice Address - State:ND
Practice Address - Zip Code:58047-7204
Practice Address - Country:US
Practice Address - Phone:701-799-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH5932124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist