Provider Demographics
NPI:1841397254
Name:OLSON, DENNIS H (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:H
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 WOODLAND LANE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9732
Mailing Address - Country:US
Mailing Address - Phone:303-439-7400
Mailing Address - Fax:303-465-3543
Practice Address - Street 1:9141 GRANT ST STE B40
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4367
Practice Address - Country:US
Practice Address - Phone:303-452-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01-167949Medicaid
CO632901OtherCIGNA
CO1C4338OtherMEDICARE
COE-06357Medicare UPIN