MEDICARE: HIATT & OLSON, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics		AR

General Provider Information

NPI Number	:	1467818146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIATT & OLSON, LLC

Provider Business Mailing Address
First Line	:	1122 S WALDRON RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2681
Country	:	US
Telephone Number	:	479-478-1900
Fax Number	:	479-478-1915

Provider Business Practice Location Address
First Line	:	1122 S WALDRON RD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2681
Country	:	US
Telephone Number	:	479-478-1900
Fax Number	:	479-478-1915

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. CHRISTOPHER A OLSON
Credential	:	DDS
Telephone Number	:	479-478-1900

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	01/11/2016

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