1942304407 NPI number — MRS. VANESSA KRISTINE STROM OLSON DDS

Table of content: MRS. VANESSA KRISTINE STROM OLSON DDS (NPI 1942304407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942304407 NPI number — MRS. VANESSA KRISTINE STROM OLSON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSON
Provider First Name:
VANESSA
Provider Middle Name:
KRISTINE STROM
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STROM
Provider Other First Name:
VANESSA
Provider Other Middle Name:
KRISTINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942304407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8971 71ST ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPICER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56288-8634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-251-9958
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5135 SKYLINE RD S
Provider Second Line Business Practice Location Address:
SKYLINE DENTAL OFFICE
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97306-9427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-251-9958
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  D8809 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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