| Organization Name: | OLYMPIA OSSEOINTEGRATION CENTER, LLC |
| NPI Number: | 1043649064 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LORI WILLIAMS (OFFICE MANAGER) |
| Mailing Address: | 1502 Bishop Rd Sw Tumwater |
| State: | WA US |
| Postal Code: | 985127354 |
| Phone Number: | 3603574500 |
| Fax Number: | 3603576170 |
| NPI Enumeration Date: | 11/12/2013 |
| NPI Last Update Date: | 11/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |