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General NPI Number Information
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NPI Number | 1255757167
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Entity Type | Organization
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Legal Business Name | MATTHEW J. OLMSTED, DDS MS PLLC
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Dates
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Enumeration Date | 03/16/2014
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Last Update Date | 03/16/2014
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Provider Practice Location Address
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Address Line | 2205 OAK RIDGE RD SUITE CC
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City | OAK RIDGE
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State | NC
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Zip | 27310-8728
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Country | US
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Telephone | 336-441-8301
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 OAK RIDGE RD SUITE CC
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City | OAK RIDGE
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State | NC
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Zip | 27310-8728
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Country | US
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Telephone | 336-441-8301
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW JOHN OLMSTED
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Credential | D.D.S., M.S.
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Telephone | 336-908-7946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 8582
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8582
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License Number State | NC
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