Individual provider Active NPI

Jeffrey J Olson, D.D.S

  • General Practice Dentistry
  • Burnsville, MN
National Provider Identifier
1205041498
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D11326 Issued in MN
Practice address
625 E Nicollet Blvd
Suite 310
Burnsville, MN 55337-6734
Phone
(952) 435-0355
Fax
(952) 435-0322
NPI assigned
May 11, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D11326 MN Primary

Addresses

Primary practice location

625 E Nicollet Blvd
Suite 310
Burnsville, MN 55337-6734

Mailing address

625 E Nicollet Blvd
Suite 310
Burnsville, MN 55337-6734
Phone (952) 435-0355

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160427000937 MN Order and Referring Only - DentistPractitioner - Dentist 3375842255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Ridge Dental, LLC General Practice Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205041498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 E NICOLLET BLVD",
            "address_2": "SUITE 310",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553376734",
            "telephone_number": "952-435-0355",
            "fax_number": "952-435-0322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E NICOLLET BLVD",
            "address_2": "SUITE 310",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553376734",
            "telephone_number": "952-435-0355",
            "fax_number": "952-435-0322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "JEFFREY",
        "middle_name": "J",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

Verify at the official NPI Registry.