Active NPI
Eric M Olson, D.D.S.
- General Practice Dentistry
- Fernandina Beach, FL
National Provider Identifier
1083678262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9689
- Practice address
- 2894 S 8TH St
Fernandina Beach, FL 32034-4462 - Phone
- (904) 261-0022
- Fax
- (904) 261-6289
- NPI assigned
- Apr 14, 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 9689 | FL | |
| General Practice Dentistry | 1223G0001X | 9689 | FL | Primary |
Addresses
Primary practice location
2894 S 8TH St
Fernandina Beach, FL 32034-4462
Mailing address
2078 Rogero Rd
Jacksonville, FL 32211-4119
Phone (904) 743-9222
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 629935 | Other | FL | UNITED CONCORDIA PROVIDER |
| 67256 | Other | FL | BCBS PROVIDER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9689 | FL | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dynamic Dental Health Associates of Florida, PA | Prosthodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Prosthodontics
- Fernandina Beach, FL
- NPI 1336574292
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641340800000",
"number": "1083678262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2078 ROGERO RD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322114119",
"telephone_number": "904-743-9222",
"fax_number": "904-745-4004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2894 S 8TH ST",
"city": "FERNANDINA BEACH",
"state": "FL",
"postal_code": "320344462",
"telephone_number": "904-261-0022",
"fax_number": "904-261-6289"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "ERIC",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-14",
"last_updated": "2022-01-05",
"certification_date": "2022-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "FL",
"license": "9689",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "9689",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA PROVIDER",
"identifier": "629935",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER",
"identifier": "67256",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fernandina Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.