Active NPI
Colin Earl Odland, DDS
- General Practice Dentistry
- West Des Moines, IA
National Provider Identifier
1679198030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DDS-09767
- Practice address
- 1089 Jordan Creek Pkwy Ste 100
West Des Moines, IA 50266-5829 - Phone
- (515) 612-7148
- NPI assigned
- Jun 11, 2020
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DDS-09767 | IA | Primary |
Addresses
Primary practice location
1089 Jordan Creek Pkwy Ste 100
West Des Moines, IA 50266-5829
Mailing address
1720 Hancock Ave
Clarion, IA 50525-7568
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 |
|---|---|---|---|
| DDS-09767 | IA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591833600000",
"number": "1679198030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1720 HANCOCK AVE",
"city": "CLARION",
"state": "IA",
"postal_code": "505257568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1089 JORDAN CREEK PKWY STE 100",
"city": "WEST DES MOINES",
"state": "IA",
"postal_code": "502665829",
"telephone_number": "515-612-7148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODLAND",
"first_name": "COLIN",
"middle_name": "EARL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-11",
"last_updated": "2020-06-11",
"certification_date": "2020-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IA",
"license": "DDS-09767",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.