Provider Demographics
NPI:1891475828
Name:GREGORY G. OLSEN, DDS, INC.
Entity Type:Organization
Organization Name:GREGORY G. OLSEN, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JADGEV
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-441-5483
Mailing Address - Street 1:4170 TRUXEL ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2370 E. BIDWELL STREET
Practice Address - Street 2:SUITE 13
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-983-6637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty