Individual
DR. BLAKE JEROME OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
101 WESTCOAST RD., REDWAY, CA 95560
(707) 923-4313
(707) 923-2590
Mailing address
101 WESTCOAST ROAD, P.O. BOX 769, REDWAY, CA 95560
(707) 953-4313
(707) 923-2590
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
56610
CA
Other
Enumeration date
11/29/2007
Last updated
11/29/2007
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