Active NPI
Grant Olson
- General Practice Dentistry
- Springfield, MO
National Provider Identifier
1497040745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2011016216
- Practice address
- 3424 S Culpepper CT
Springfield, MO 65804-3755 - Phone
- (417) 343-1266
- NPI assigned
- Jun 15, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2011016216 | MO | Primary |
Addresses
Primary practice location
3424 S Culpepper CT
Springfield, MO 65804-3755
Mailing address
3424 S Culpepper CT
Springfield, MO 65804-3755
Phone (417) 343-1266
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2011016216 | MO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349136000000",
"number": "1497040745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3424 S CULPEPPER CT",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658043755",
"telephone_number": "417-343-1266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3424 S CULPEPPER CT",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658043755",
"telephone_number": "417-343-1266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "GRANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-15",
"last_updated": "2012-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "2011016216",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.