Provider Demographics
NPI:1962622753
Name:OLSON, MARK ELLIOT (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ELLIOT
Last Name:OLSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220-0635
Mailing Address - Country:US
Mailing Address - Phone:701-265-8777
Mailing Address - Fax:701-265-8777
Practice Address - Street 1:202 E 3RD AVE S
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-0635
Practice Address - Country:US
Practice Address - Phone:701-265-8777
Practice Address - Fax:701-265-8777
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND15301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice