Provider Demographics
NPI:1760642045
Name:OLSON, RYAN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
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 1:500 E. CENTRAL TEXAS EXPESSWAY
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5606
Mailing Address - Country:US
Mailing Address - Phone:254-698-4698
Mailing Address - Fax:254-698-3590
Practice Address - Street 1:2201 EAST GALA STREET
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-888-3033
Practice Address - Fax:208-888-3393
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239661223G0001X
IDD44551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice