MEDICARE: DR. BRIAN R. OLESON

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	261QD0000X	Dental Clinic/Center	DE00005463	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	:	1790902542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. BRIAN R. OLESON

Provider Business Mailing Address
First Line	:	PO BOX 817
Second Line	:
City	:	HOODSPORT
State	:	WA
Zip	:	98548-0817
Country	:	US
Telephone Number	:	360-877-5151
Fax Number	:	360-877-5134

Provider Business Practice Location Address
First Line	:	N. 68 LAKE CUSHMAN RD.
Second Line	:
City	:	HOODSPORT
State	:	WA
Zip	:	98548-0817
Country	:	US
Telephone Number	:	360-877-5151
Fax Number	:	360-877-5134

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIAN R. OLESON
Credential	:	D.D.S.
Telephone Number	:	360-877-5151

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	08/22/2020

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