Healthcare Provider Details

I. General information

NPI: 1710458732
Provider Name (Legal Business Name): STEPHEN G OLMSTEAD III, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16717 US HIGHWAY 17 N STE 224
HAMPSTEAD NC
28443-3497
US

IV. Provider business mailing address

16717 US HIGHWAY 17 N STE 224
HAMPSTEAD NC
28443-3497
US

V. Phone/Fax

Practice location:
  • Phone: 910-270-0728
  • Fax: 910-270-8702
Mailing address:
  • Phone: 910-270-0728
  • Fax: 910-270-8702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN THACKER
Title or Position: BILLING COORDINATOR
Credential:
Phone: 910-270-0728