Healthcare Provider Details

I. General information

NPI: 1306803523
Provider Name (Legal Business Name): DR. JOHN S OLMSTED
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 BENJAMIN PKWY
GREENSBORO NC
27408-2015
US

IV. Provider business mailing address

1602 BENJAMIN PKWY
GREENSBORO NC
27408-2015
US

V. Phone/Fax

Practice location:
  • Phone: 336-288-0010
  • Fax: 336-282-5754
Mailing address:
  • Phone: 336-288-0010
  • Fax: 336-282-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4102
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: