MEDICARE: BRYAN DANIEL OLSON DDS

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	122300000X	Dentist	5857	WA

General Provider Information

NPI Number	:	1669574919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN DANIEL OLSON DDS

Provider Business Mailing Address
First Line	:	3340 NE 125TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125
Country	:	US
Telephone Number	:	206-363-6868
Fax Number	:	206-363-0290

Provider Business Practice Location Address
First Line	:	3340 NE 125TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125
Country	:	US
Telephone Number	:	206-363-6868
Fax Number	:	206-363-0290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/08/2007

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