Provider Demographics
NPI:1124307590
Name:OLSON, LEAH (DMD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:OLSON
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 1:1800 COOPER POINT RD SW STE 23
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1179
Mailing Address - Country:US
Mailing Address - Phone:360-352-1330
Mailing Address - Fax:
Practice Address - Street 1:1800 COOPER POINT RD SW STE 23
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1179
Practice Address - Country:US
Practice Address - Phone:360-330-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602313721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice