Provider Demographics
NPI:1447554795
Name:OLSON, DAVID JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:OLSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 UNITY ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4429
Mailing Address - Country:US
Mailing Address - Phone:360-676-6177
Mailing Address - Fax:360-527-8778
Practice Address - Street 1:5616 3RD AVENUE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248
Practice Address - Country:US
Practice Address - Phone:360-752-7410
Practice Address - Fax:360-383-0808
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60199790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist