Provider Demographics
NPI:1942304407
Name:OLSON, VANESSA KRISTINE STROM (DDS)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:KRISTINE STROM
Last Name:OLSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:VANESSA
Other - Middle Name:KRISTINE
Other - Last Name:STROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8971 71ST ST NE
Mailing Address - Street 2:
Mailing Address - City:SPICER
Mailing Address - State:MN
Mailing Address - Zip Code:56288-8634
Mailing Address - Country:US
Mailing Address - Phone:612-251-9958
Mailing Address - Fax:
Practice Address - Street 1:5135 SKYLINE RD S
Practice Address - Street 2:SKYLINE DENTAL OFFICE
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9427
Practice Address - Country:US
Practice Address - Phone:612-251-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist