Healthcare Provider Details

I. General information

NPI: 1760059265
Provider Name (Legal Business Name): ALEXANDER TUBBS OLMSTEAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 3RD AVE STE 204
HAVRE MT
59501-3554
US

IV. Provider business mailing address

302 20TH ST
HAVRE MT
59501-5233
US

V. Phone/Fax

Practice location:
  • Phone: 406-262-7722
  • Fax:
Mailing address:
  • Phone: 385-319-6131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: