NPIMap

Organization Active NPI

Olympic Dentistry, PLC

  • Dental Clinic/Center
  • Waterloo, IA
National Provider Identifier
1104036755
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
07466 Issued in IA
Legal business name
OLYMPIC DENTISTRY, PLC
Practice address
208 Olympic Dr
Waterloo, IA 50701-5240
Phone
(319) 234-3233
Fax
(319) 234-3879
NPI assigned
May 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Brent Eugene Ludens, D.D.S.NPI 1740400951
Title
Owner
Phone
(319) 234-3233

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 07466 IA Primary

Addresses

Primary practice location

208 Olympic Dr
Waterloo, IA 50701-5240

Mailing address

208 Olympic Drive
Waterloo, IA 50701-5240
Phone (319) 234-3233

National Provider Directory

National Provider Directory

Locations

208 Olympic Dr
Waterloo, IA 50701
Phone (319) 234-3233

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104036755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 OLYMPIC DRIVE",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507015240",
            "telephone_number": "319-234-3233",
            "fax_number": "319-234-3879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 OLYMPIC DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507015240",
            "telephone_number": "319-234-3233",
            "fax_number": "319-234-3879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLYMPIC DENTISTRY, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LUDENS",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "319-234-3233",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IA",
            "license": "07466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.