1235509639 NPI number — MICHELLE R OLMSTEAD, DDS, PLLC

Table of content: (NPI 1235509639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235509639 NPI number — MICHELLE R OLMSTEAD, DDS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHELLE R OLMSTEAD, DDS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235509639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1328 N STANFORD LN
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LIBERTY LAKE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99019-5034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-891-5001
Provider Business Mailing Address Fax Number:
509-891-2787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4610 N ASH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99205-1482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-891-5001
Provider Business Practice Location Address Fax Number:
509-891-2787
Provider Enumeration Date:
09/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
OLMSTEAD
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
509-891-5001

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DE00008465 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5032438 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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