Provider Demographics
NPI:1518077577
Name:OLSSON, JOHN DWIGHT (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DWIGHT
Last Name:OLSSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9013 KEY PENINSULA HWY N
Mailing Address - Street 2:
Mailing Address - City:LAKEBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98349
Mailing Address - Country:US
Mailing Address - Phone:253-884-9455
Mailing Address - Fax:253-884-9466
Practice Address - Street 1:9013 KEY PENINSULA HWY N
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349
Practice Address - Country:US
Practice Address - Phone:253-884-9455
Practice Address - Fax:253-884-9466
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000054641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice