Provider Demographics
NPI:1841343225
Name:OLSON, RICHARD H (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:OLSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4072
Mailing Address - Country:US
Mailing Address - Phone:509-525-7330
Mailing Address - Fax:509-525-2398
Practice Address - Street 1:860 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4072
Practice Address - Country:US
Practice Address - Phone:509-525-7330
Practice Address - Fax:509-525-2398
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007888122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist