Brett R Olm, DDS MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

4923-015 Issued in WI

Practice address

525 Airport Dr
Oneida, WI 54155-9035

Phone

(920) 869-2711

NPI assigned

Oct 12, 2006

Last updated

Oct 9, 2007By 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 WI

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

Master of Science

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.

• Oneida Nation

  • Clinic/Center
  • Oneida, WI
  • NPI 1740278308
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191888000000",
    "number": "1811086135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "548 REDBIRD CIR",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541158785",
            "telephone_number": "920-964-0144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 AIRPORT DR",
            "city": "ONEIDA",
            "state": "WI",
            "postal_code": "541559035",
            "telephone_number": "920-869-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLM",
        "first_name": "BRETT",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WI",
            "license": "4923-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kalyn Elizabeth Leege, PTA
• Heidi McCann, RD
• Kaitlyn Moser, RD, CD
• Timothy A Moureau, APNP CDE
• Bridget A Nelson, RDH
• Oneida Nation
• Oneida Nation (Anna John Resident Centered Care Community)
• Oneida Nation (Oneida Community Health Center LTC Pharmacy)
• Oneida Nation
• Oneida Nation

• Orthodontics and Dentofacial Orthopedics Dentistry in Oneida, WI
• Providers in Oneida, WI by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.