Provider Demographics
NPI:1205156775
Name:OLSEN, GREGORY G (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:G
Last Name:OLSEN
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:2370 E BIDWELL
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3463
Mailing Address - Country:US
Mailing Address - Phone:916-983-6637
Mailing Address - Fax:916-983-6610
Practice Address - Street 1:2370 E BIDWELL
Practice Address - Street 2:SUITE 130
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3463
Practice Address - Country:US
Practice Address - Phone:916-983-6637
Practice Address - Fax:916-983-6610
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2013-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0191272701223S0112X
CA593601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery