Active NPI
Scott R Olsen, DDS
- Dentist
- Lakewood, WA
National Provider Identifier
1063423986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE00008764
- Practice address
- 7424 Bridgeport Way W
Lakewood, WA 98499-8120 - Phone
- (253) 581-2112
- Fax
- (253) 240-2102
- NPI assigned
- Aug 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE00008764 | WA | |
| Dentist | 122300000X | DE00008764 | WA | Primary |
Addresses
Primary practice location
7424 Bridgeport Way W
Lakewood, WA 98499-8120
Mailing address
PO Box 34703
Seattle, WA 98124-1703
Other practice location 1
3622 Ensign Rd NE Ste D
Olympia, WA 98506-5081
Phone (360) 570-8016
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5034392 | Medicaid | WA |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151113001866 | WA | Order and Referring Only - Dentist | 9830409267 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00008764 | WA | MD | Dentist |
Networks
- WA PPO C-SNP
Interoperability endpoints
- solsen452821@direct.multicare.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740096000000",
"number": "1063423986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 34703",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981241703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7424 BRIDGEPORT WAY W",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984998120",
"telephone_number": "253-581-2112",
"fax_number": "253-240-2102"
}
],
"practiceLocations": [
{
"address_1": "3622 Ensign Rd NE Ste D",
"address_purpose": "LOCATION",
"city": "Olympia",
"state": "WA",
"postal_code": "985065081",
"country_code": "US",
"telephone_number": "360-570-8016",
"fax_number": "360-570-8275",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OLSEN",
"first_name": "SCOTT",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-10",
"last_updated": "2025-02-21",
"certification_date": "2025-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DE00008764",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE00008764",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5034392",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; 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.