Provider Demographics
NPI:1285017301
Name:OLSON, JASMINE (DDS)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 166TH AVE NE STE 103
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3999
Mailing Address - Country:US
Mailing Address - Phone:425-300-9056
Mailing Address - Fax:
Practice Address - Street 1:8105 166TH AVE NE STE 103
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3999
Practice Address - Country:US
Practice Address - Phone:425-300-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE605752711223G0001X, 125Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125Q00000XDental ProvidersDentistOral Medicine
No1223G0001XDental ProvidersDentistGeneral Practice