Matthew Gibb Olsen, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

2024014437 Issued in MO

Practice address

1001 Shadow LN
Las Vegas, NV 89106-4124

Phone

(435) 773-8566

NPI assigned

May 25, 2023

Last updated

Apr 23, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Seneca Family Smiles P L L C

  • Dentist
  • Seneca, MO
  • NPI 1396480976
  NPD (past)

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

{
    "created_epoch": "1684972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1255023396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 CHESTNUT ST",
            "city": "SENECA",
            "state": "MO",
            "postal_code": "648659261",
            "telephone_number": "435-773-8566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 SHADOW LN",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064124",
            "telephone_number": "435-773-8566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "MATTHEW",
        "middle_name": "GIBB",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-25",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2024014437",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana M. Olsen
• Doris Mae Olsen, COTA
• Jarvis Olsen, APRN
• Jeffery James Olsen, DO
• Kacey Olsen
• Robert G. Olsen, AU. D.
• Sarah Christine Olsen, MPA, BCBA, LBA
• Stephanie Olsen
• Ashley Olshove, OTD
• Charissa Olson Caldera, M.D.

• Dentist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Dentist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.