Brock L Olson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1284 Issued in WY

Practice address

621 N 8TH St W
Riverton, WY 82501-3318

Phone

(307) 856-9725

Fax

(307) 856-7075

NPI assigned

Jul 11, 2011

Last updated

Jul 11, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

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

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.

• Benchmark Dental, PC

  • Dentist
  • Riverton, WY
  • NPI 1972832616
  NPD (past)
• Dr. Josh Fowler, DMD, PC

  • General Practice Dentistry
  • Riverton, WY
  • NPI 1174782486
  NPD (past)

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

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310342400000",
    "number": "1184912263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 N 8TH ST W",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "825013318",
            "telephone_number": "307-856-9725",
            "fax_number": "307-856-7075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 N 8TH ST W",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "825013318",
            "telephone_number": "307-856-9725",
            "fax_number": "307-856-7075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "BROCK",
        "middle_name": "L",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-11",
        "last_updated": "2011-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WY",
            "license": "1284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Notopoulos
• Oak Haven Dental
• Daniel James Oldman
• Michaela Ruth Oldman
• Zachary Olivarez
• Jessica Ortiz
• Kathy Osborne
• Maureen Fay Osborne, MA,CCC/SLP
• William Alan Owens, R.PH.
• Rebecca L. Parker, MS, LPC

• General Practice Dentistry in Riverton, WY
• Providers in Riverton, WY by specialty
• General Practice Dentistry in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2011; 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.