Healthcare Provider Details

I. General information

NPI: 1649000944
Provider Name (Legal Business Name): OLMSTEAD & STANBERY DENTAL PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 BERYWOOD TRL NW
CLEVELAND TN
37312-5285
US

IV. Provider business mailing address

413 BERYWOOD TRL NW
CLEVELAND TN
37312-5285
US

V. Phone/Fax

Practice location:
  • Phone: 423-478-3756
  • Fax:
Mailing address:
  • Phone: 423-478-3756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA R OLMSTEAD
Title or Position: PARTNER
Credential: DDS
Phone: 423-715-2758