# LIBERTY LAKE FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255658886
- **Authorized official:** MRS. MICHELLE R OLMSTEAD DDS (DOCTOR/OWNER)
- **Authorized official phone:** (509) 891-5001

## Contact information

- **Practice address:** 2207 N MOLTER RD, SUITE 200, LIBERTY LAKE, WA 99019-7570
- **Practice address phone:** (509) 891-5001
- **Practice address fax:** (509) 891-2787
- **Mailing address:** 2207 N MOLTER RD, SUITE 200, LIBERTY LAKE, WA 99019-7570
- **Mailing address phone:** (509) 891-5001
- **Mailing address fax:** (509) 891-2787

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE00008465 | WA | Yes |

## Other

- **Enumeration date:** 04/21/2010
- **Last updated:** 04/21/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5032438 | — | WA |