Anthony Ewell-Kollmann, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

34647 Issued in TX

Practice address

90 Hope Dr
Mountain Home AFB, ID 83648-1057

Phone

(208) 828-7355

NPI assigned

Sep 24, 2018

Last updated

Sep 26, 2022By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1952885121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7015 IMLAY LOOP",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836484801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 HOPE DR",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481057",
            "telephone_number": "208-828-7355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2630 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Eielson AFB",
            "state": "AK",
            "postal_code": "99702",
            "country_code": "US",
            "telephone_number": "907-377-6569",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Offutt Air Force Base",
            "address_purpose": "LOCATION",
            "city": "APO",
            "state": "AA",
            "postal_code": "68113",
            "country_code": "US",
            "telephone_number": "402-294-1110",
            "country_name": "United States",
            "address_type": "MIL"
        }
    ],
    "basic": {
        "last_name": "EWELL-KOLLMANN",
        "first_name": "ANTHONY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-24",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "34647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derek J Dutson, D.M.D.
• Mary Dolores Dvorak, MD
• Le Ann Marie Egan
• Zane Elliott, IDMT
• David J Emert
• Teagan Ferguson, DPT
• Jerrold Neil Flyer, MD
• Craig Loyd Folsom, D.D.S.
• Dakota T Freve, M.D.
• Heather Marie Funk, MS, RDN, LDN

• Dentist in Mountain Home AFB, ID
• Providers in Mountain Home AFB, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; 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.