Kelly J. Olsen, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

309573 Issued in UT

Practice address

321 N Mall Dr
Suite #D101
St George, UT 84790-7302

Phone

(435) 628-5496

Fax

(435) 628-6285

NPI assigned

Jan 26, 2007

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 UT

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 and National Provider Directory roles.

• Utah Mountain Dental Partners PC

  • Dental Clinic/Center
  • St George, UT
  • NPI 1932948825
  NPD (past)

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407902950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 N MALL DR",
            "address_2": "SUITE #D101",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847907302",
            "telephone_number": "435-628-5496",
            "fax_number": "435-628-6285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 N MALL DR",
            "address_2": "SUITE #D101",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847907302",
            "telephone_number": "435-628-5496",
            "fax_number": "435-628-6285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "KELLY",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "309573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bradley James Olsen, DNP
• Brianna K Olsen, RDN
• Emily Olsen
• Gracie Olsen
• Hallie B Olsen, LMT
• Kirsta Olsen, CSW
• Zachary D Olsen, NP
• Alese Olson
• Annalise Ruth Olson
• Benjamin Olson

• General Practice Dentistry in St George, UT
• Providers in St George, UT by specialty
• General Practice Dentistry in Utah

• 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.