Healthcare Provider Details

I. General information

NPI: 1386025013
Provider Name (Legal Business Name): BECKY ANN OLACKE D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 NE 74TH ST
SEATTLE WA
98115-8158
US

IV. Provider business mailing address

6222 NE 74TH ST
SEATTLE WA
98115-8158
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-7906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDR60560330
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: