Provider Demographics
NPI:1013409788
Name:SCOTT A OLSON DDS PLLC
Entity Type:Organization
Organization Name:SCOTT A OLSON DDS PLLC
Other - Org Name:VIKING DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-598-5510
Mailing Address - Street 1:18520 STATE HIGHWAY 305 NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7453
Mailing Address - Country:US
Mailing Address - Phone:360-598-5510
Mailing Address - Fax:360-598-5515
Practice Address - Street 1:18520 STATE HIGHWAY 305 NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7453
Practice Address - Country:US
Practice Address - Phone:360-598-5510
Practice Address - Fax:360-598-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010620261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental