MEDICARE: MICHELLE RENEE OLMSTEAD 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	1223G0001X	General Practice Dentistry	25103/DE00008465	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063523165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RENEE OLMSTEAD DDS

Provider Business Mailing Address
First Line	:	2207 N MOLTER RD
Second Line	:	SUITE 200
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-7570
Country	:	US
Telephone Number	:	509-891-5001
Fax Number	:	509-891-2787

Provider Business Practice Location Address
First Line	:	2207 N MOLTER RD
Second Line	:	SUITE 200
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-7570
Country	:	US
Telephone Number	:	509-891-5001
Fax Number	:	509-891-2787

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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