MEDICARE: DR. CHRISTINE OLSON DMD

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	D11472	OR

General Provider Information

NPI Number	:	1194397539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE OLSON DMD

Provider Business Mailing Address
First Line	:	1250 E BURNSIDE ST APT 236
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2270
Country	:	US
Telephone Number	:	815-481-3395
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 N LOMBARD ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5533
Country	:	US
Telephone Number	:	503-379-0566
Fax Number	:

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

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	07/14/2021

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