Gregory Alan Olson, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D10240 Issued in MN

Practice address

5509 Eden Prairie Rd
Minnetonka, MN 55345-5839

Phone

(952) 938-6038

Fax

(952) 935-9175

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Glen Lake Family Dentistry P.L.L.C.

  • General Practice Dentistry
  • Minnetonka, MN
  • NPI 1740215656
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256083200000",
    "number": "1184659435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5509 EDEN PRAIRIE RD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553455839",
            "telephone_number": "952-938-6038",
            "fax_number": "952-935-9175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5509 EDEN PRAIRIE RD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553455839",
            "telephone_number": "952-938-6038",
            "fax_number": "952-935-9175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "GREGORY",
        "middle_name": "ALAN",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2009-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D10240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL ASSISTANCE#",
            "identifier": "674718300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethany Olson
• Carol Ann Olson, NURSE PRACTITIONER
• Catherine Olson
• Courtney Olson
• Emily Olson, LSW, LADC
• James Odin Olson, DDS
• Jay R Olson, OD
• Jonathan Michael Olson
• Kendall Marie Olson
• Macy Ruth Olson

• Dentist in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.