MEDICARE: MATTHEW J. OLMSTED, DDS MS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	8582	NC
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	8582	NC

General Provider Information

NPI Number	:	1255757167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW J. OLMSTED, DDS MS PLLC

Provider Business Mailing Address
First Line	:	2205 OAK RIDGE RD
Second Line	:	SUITE CC
City	:	OAK RIDGE
State	:	NC
Zip	:	27310-8728
Country	:	US
Telephone Number	:	336-441-8301
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 OAK RIDGE RD
Second Line	:	SUITE CC
City	:	OAK RIDGE
State	:	NC
Zip	:	27310-8728
Country	:	US
Telephone Number	:	336-441-8301
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW JOHN OLMSTED
Credential	:	D.D.S., M.S.
Telephone Number	:	336-908-7946

Provider Enumeration Date	:	03/16/2014
Last Update Date	:	03/16/2014

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