Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 03/16/2014
Last Update Date: 03/16/2014
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:
Mailing address:
  • Phone: 336-441-8301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8582
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number8582
License Number StateNC

VIII. Authorized Official

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