Healthcare Provider Details

I. General information

NPI: 1639186281
Provider Name (Legal Business Name): GREGORY WILLIAM OLSON DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/09/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 CAMBRIDGE ST STE 3410
HOUSTON TX
77054-2032
US

IV. Provider business mailing address

7500 CAMBRIDGE ST STE 3410
HOUSTON TX
77054-2032
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-8222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number43475
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number43475
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number34762
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: