Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DEN.00204844 | CO |
NPI | 1700410248 |
---|---|
Provider Name | Ayathi Olson |
First Address | Highlands Ranch, CO 80126-5217 |
Second Address | Denver, CO 80205-2827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2020 |
Last Update Date | 19/08/2021 |