Provider Demographics
NPI:1669503272
Name:OLSON, KATHRINE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHRINE
Middle Name:A
Last Name:OLSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-9712
Mailing Address - Country:US
Mailing Address - Phone:509-924-9596
Mailing Address - Fax:509-924-4848
Practice Address - Street 1:210 S SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-9712
Practice Address - Country:US
Practice Address - Phone:509-924-9596
Practice Address - Fax:509-924-4848
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA49441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice