NPIMap

Organization Active NPI

Olympic Dental Center, LLC

  • Dental Clinic/Center
  • Lacey, WA
National Provider Identifier
1780733204
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
OLYMPIC DENTAL CENTER, LLC
Practice address
4408 Pacific Ave SE
Lacey, WA 98503-1119
Phone
(360) 438-8299
Fax
(360) 438-1399
NPI assigned
Jan 10, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. John Anderson, D.P.DNPI 1366560302
Title
Denturist
Phone
(360) 438-8299

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

4408 Pacific Ave SE
Lacey, WA 98503-1119

Mailing address

4408 Pacific Ave SE
Lacey, WA 98503-1119
Phone (360) 438-8299

Other identifiers 2

IdentifierTypeStateIssuer
1412978OtherWAUNITED CONCORDIA
5040258MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Olympic Dental Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4408 Pacific Ave SE
Lacey, WA 98503
Phone (360) 438-8299

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780733204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4408 PACIFIC AVE SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031119",
            "telephone_number": "360-438-8299",
            "fax_number": "360-438-1399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4408 PACIFIC AVE SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031119",
            "telephone_number": "360-438-8299",
            "fax_number": "360-438-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLYMPIC DENTAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "DENTURIST",
        "authorized_official_telephone_number": "360-438-8299",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.P.D"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1412978",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5040258",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lacey, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.