Provider Demographics
NPI:1104496868
Name:OLANDER, DARCY KAE (DMD)
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:KAE
Last Name:OLANDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 FILLMORE AVE NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3785
Mailing Address - Country:US
Mailing Address - Phone:503-949-8568
Mailing Address - Fax:
Practice Address - Street 1:4600 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4648
Practice Address - Country:US
Practice Address - Phone:503-949-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD114561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice