Provider Demographics
NPI:1942342498
Name:OLSON BOLIN, LOREE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOREE
Middle Name:D
Last Name:OLSON BOLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LOREE
Other - Middle Name:
Other - Last Name:BOLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:515 HIGHWAY 9
Mailing Address - Street 2:SUITE #102
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258
Mailing Address - Country:US
Mailing Address - Phone:425-334-6912
Mailing Address - Fax:425-334-1614
Practice Address - Street 1:515 HIGHWAY 9
Practice Address - Street 2:SUITE #102
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258
Practice Address - Country:US
Practice Address - Phone:425-334-6912
Practice Address - Fax:425-334-1614
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist