Brant N Olson, D.D.S.,P.A.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3386 Issued in ID

Practice address

250 S Skyline Dr
Suite 5
Idaho Falls, ID 83402-3292

Phone

(208) 522-9101

Fax

(208) 522-2517

NPI assigned

Jul 19, 2006

Sex

Male

Sole proprietor

Yes

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 ID

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

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285653071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 S SKYLINE DR",
            "address_2": "SUITE 5",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023292",
            "telephone_number": "208-522-9101",
            "fax_number": "208-522-2517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 S SKYLINE DR",
            "address_2": "SUITE 5",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023292",
            "telephone_number": "208-522-9101",
            "fax_number": "208-522-2517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "BRANT",
        "middle_name": "N",
        "credential": "D.D.S.,P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Shane Oldfield I, LMSW
• James Michael Oldroyd, M D
• Cody Lamar Oliverson, CRNA
• Garrett Olsen, DO
• Jaren Olsen, OD
• Brian Lane Olson
• Eric Olson, LCPC
• Eric Peter Olson, MD
• Jonathan Allred Olson
• Melissa Olson, IS

• General Practice Dentistry in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.