Provider Demographics
NPI:1861735920
Name:OLESYA Z. SALATHE, DMD, LLC
Entity type:Organization
Organization Name:OLESYA Z. SALATHE, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:OLESYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALATHE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-829-9731
Mailing Address - Street 1:PO BOX 657
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-0657
Mailing Address - Country:US
Mailing Address - Phone:503-829-9731
Mailing Address - Fax:503-427-9766
Practice Address - Street 1:106 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038-9195
Practice Address - Country:US
Practice Address - Phone:503-829-9731
Practice Address - Fax:503-427-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD94761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty