MEDICARE: SCOTT M OLSON DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	016006	MO

General Provider Information

NPI Number	:	1417140294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT M OLSON DMD

Provider Business Mailing Address
First Line	:	1722 S GLENSTONE AVE
Second Line	:	SUITE GG
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-1513
Country	:	US
Telephone Number	:	417-823-4900
Fax Number	:	417-823-8333

Provider Business Practice Location Address
First Line	:	1722 S GLENSTONE AVE
Second Line	:	SUITE GG
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-1513
Country	:	US
Telephone Number	:	417-823-4900
Fax Number	:	417-823-8333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	08/24/2007

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