Active NPI
Tad Olsen
- Dentist
- Mesa, AZ
National Provider Identifier
1144756016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D009695
- Practice address
- 1130 S Country Club Dr
Mesa, AZ 85210-4639 - Phone
- (480) 461-9866
- NPI assigned
- May 11, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D009695 | AZ | Primary |
Addresses
Primary practice location
1130 S Country Club Dr
Mesa, AZ 85210-4639
Mailing address
1293 S 480 W
Salem, UT 84653-9108
Phone (801) 420-1933
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 |
|---|---|---|---|
| D009695 | AZ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494460800000",
"number": "1144756016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1293 S 480 W",
"city": "SALEM",
"state": "UT",
"postal_code": "846539108",
"telephone_number": "801-420-1933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 S COUNTRY CLUB DR",
"city": "MESA",
"state": "AZ",
"postal_code": "852104639",
"telephone_number": "480-461-9866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSEN",
"first_name": "TAD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-05-11",
"last_updated": "2017-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D009695",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.