MEDICARE: DR. GREGORY WILLIAM OLSON DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	43475	CA
2	1223P0221X	Pediatric Dentistry	43475	CA
3	1223P0221X	Pediatric Dentistry	34762	TX

General Provider Information

NPI Number	:	1639186281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY WILLIAM OLSON DDS, MS

Provider Business Mailing Address
First Line	:	7500 CAMBRIDGE ST STE 3410
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 CAMBRIDGE ST STE 3410
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2032
Country	:	US
Telephone Number	:	713-500-8222
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	11/09/2022

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