Healthcare Provider Details

I. General information

NPI: 1508023946
Provider Name (Legal Business Name): MATTHEW JOHN OLMSTED DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 OAK RIDGE RD SUITE CC
OAK RIDGE NC
27310-8728
US

IV. Provider business mailing address

2205 OAK RIDGE RD SUITE CC
OAK RIDGE NC
27310-8728
US

V. Phone/Fax

Practice location:
  • Phone: 336-441-8301
  • Fax: 336-441-8302
Mailing address:
  • Phone: 336-441-8301
  • Fax: 336-441-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8582
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8582
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: