Active NPI
Mark Gregory Olson, D.D.S.
- Dentist
- Stillwater, MN
National Provider Identifier
1871646588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8373
- Practice address
- 13961 60TH St N
Stillwater, MN 55082-1053 - Phone
- (651) 209-6312
- NPI assigned
- Jan 18, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 8373 | MN | Primary |
Addresses
Primary practice location
13961 60TH St N
Stillwater, MN 55082-1053
Mailing address
10645 Saint Croix TRL
North Branch, MN 55056-6775
Phone (651) 674-1874
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160428001460 | MN | Order and Referring Only - Oral Surgery | 2365741139 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8373 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511136000000",
"number": "1871646588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10645 SAINT CROIX TRL",
"city": "NORTH BRANCH",
"state": "MN",
"postal_code": "550566775",
"telephone_number": "651-674-1874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13961 60TH ST N",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550821053",
"telephone_number": "651-209-6312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "MARK",
"middle_name": "GREGORY",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2017-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "8373",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stillwater, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2017; 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.