| Doctor Name: | MR. ELDRED DONALD OLSON |
| NPI Number: | 1003977091 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LICENSED DENTURIST |
| License Number: | DN00023 |
| Business Practice Address: | 1346 12th St Clarkston, WA - 994032821 |
| Business Phone Number: | 5097587805 |
| Business Fax Number: | 5097511510 |
| Mailing Address: | 1346 12th St, Clarkston Denturist Clinic CLARKSTON |
| State: | WA |
| Postal Code: | 99403 |
| Phone Number: | 5097587805 |
| Fax Number: | 5097511510 |
| NPI Enumeration Date: | 12/13/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | DN00023 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |