Tina M. Olsson, D.M.D., M.S.D

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

DEN00011163 Issued in WA

Practice address

412 Bowes Dr
Fircrest, WA 98466

Phone

(253) 752-5511

Fax

(253) 752-4442

NPI assigned

Jun 8, 2006

Last updated

Jun 12, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Tina Moana-Marie Obryant Former name

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Niazi & Sharaki PLLC

  dba Puget Sound Endodontics & Associates

  • Endodontics
  • Silverdale, WA
  • NPI 1801403936
  NPD
• Niazi & Sharaki PLLC

  dba South Sound Endodontics

  • Endodontics
  • University Place, WA
  • NPI 1235053398
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560297600000",
    "number": "1053351791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 BOWES DR",
            "city": "FIRCREST",
            "state": "WA",
            "postal_code": "98466",
            "telephone_number": "253-752-5511",
            "fax_number": "253-752-4442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 BOWES DR",
            "city": "FIRCREST",
            "state": "WA",
            "postal_code": "98466",
            "telephone_number": "253-752-5511",
            "fax_number": "253-752-4442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1123 R St NW",
            "address_purpose": "LOCATION",
            "city": "Auburn",
            "state": "WA",
            "postal_code": "980013848",
            "country_code": "US",
            "telephone_number": "240-381-4065",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLSSON",
        "first_name": "TINA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.S.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2019-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "WA",
            "license": "DE00011163",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "WA",
            "license": "DEN00011163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TINA",
            "last_name": "OBRYANT",
            "middle_name": "MOANA-MARIE",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Endodontics in Fircrest, WA
• Providers in Fircrest, WA by specialty
• Endodontics in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.