NPI 1225769227

Bradley Olsen, CDT

Practitioner Dental Therapist Fairmont, MN

Practice location

Address: 717 S State St STE 2, Fairmont, MN 56031-4469
Phone: (507) 235-5985

Registered specialties

Dental Therapist Primary

Dental Providers Taxonomy 125J00000X Licence DT150 (MN)

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Registry record

NPI: 1225769227
Entity type: Individual
Sex (as registered): Male
NPI issued: 21 Jun 2022
Record last updated: 21 Jun 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.