Provider Demographics
NPI:1225193352
Name:SCOTT M OLSON DMD PC
Entity Type:Organization
Organization Name:SCOTT M OLSON DMD PC
Other - Org Name:PREMIER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:417-823-4900
Mailing Address - Street 1:1722 S GLENSTONE AVE
Mailing Address - Street 2:STE GG
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1519
Mailing Address - Country:US
Mailing Address - Phone:417-823-4900
Mailing Address - Fax:417-823-8333
Practice Address - Street 1:1722 S GLENSTONE AVE
Practice Address - Street 2:STE GG
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1519
Practice Address - Country:US
Practice Address - Phone:417-823-4900
Practice Address - Fax:417-823-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty