NPIMap

Organization Active NPI

Olson Dental Associates P.S.C.

  • Dental Clinic/Center
  • Saint Paul, MN
National Provider Identifier
1518298660
Registry record updated Jan 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
8085 Issued in MN
Legal business name
OLSON DENTAL ASSOCIATES P.S.C.
Practice address
393 Dunlap St N
Suite 308
Saint Paul, MN 55104-4200
Phone
(651) 788-7045
NPI assigned
Jan 28, 2010
Last updated
Jan 28, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2010

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

Authorized official

Name
Dr. Kenneth M Olson, D.D.S.
Title
Owner
Phone
(651) 788-7045

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 8085 MN Primary

Addresses

Primary practice location

393 Dunlap St N
Suite 308
Saint Paul, MN 55104-4200

Mailing address

393 Dunlap St N
Suite 308
Saint Paul, MN 55104-4200
Phone (651) 788-7045

Other identifiers 1

IdentifierTypeStateIssuer
1235322504MedicaidMN

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1264636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264636800000",
    "number": "1518298660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 DUNLAP ST N",
            "address_2": "SUITE 308",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044200",
            "telephone_number": "651-788-7045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "393 DUNLAP ST N",
            "address_2": "SUITE 308",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044200",
            "telephone_number": "651-788-7045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLSON DENTAL ASSOCIATES P.S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-28",
        "last_updated": "2010-01-28",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-788-7045",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "8085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235322504",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2010; 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.