Provider Demographics
NPI:1346578309
Name:OLYMPIA DENTAL CENTER
Entity Type:Organization
Organization Name:OLYMPIA DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:T K
Authorized Official - Last Name:WAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:360-241-7943
Mailing Address - Street 1:2705 LIMITED LN NW STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-6504
Mailing Address - Country:US
Mailing Address - Phone:360-943-4300
Mailing Address - Fax:360-357-7968
Practice Address - Street 1:2705 LIMITED LN NW STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6504
Practice Address - Country:US
Practice Address - Phone:360-943-4300
Practice Address - Fax:360-357-7968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 9109261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental