Healthcare Provider Details

I. General information

NPI: 1063523165
Provider Name (Legal Business Name): MICHELLE RENEE OLMSTEAD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 N MOLTER RD SUITE 200
LIBERTY LAKE WA
99019-7570
US

IV. Provider business mailing address

2207 N MOLTER RD SUITE 200
LIBERTY LAKE WA
99019-7570
US

V. Phone/Fax

Practice location:
  • Phone: 509-891-5001
  • Fax: 509-891-2787
Mailing address:
  • Phone: 509-891-5001
  • Fax: 509-891-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25103/DE00008465
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: