Provider Demographics
NPI:1477622256
Name:OLSON, THOMAS MURRAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MURRAY
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 1:920 CENTRAL AVE N
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-3048
Mailing Address - Country:US
Mailing Address - Phone:253-813-5571
Mailing Address - Fax:253-813-1916
Practice Address - Street 1:920 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-3048
Practice Address - Country:US
Practice Address - Phone:253-813-5571
Practice Address - Fax:253-813-1916
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000079211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5028774Medicaid