MEDICARE: DR. MATTHEW JOHN OLMSTED DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8582	NC
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	8582	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508023946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW JOHN OLMSTED DDS, MS

Provider Business Mailing Address
First Line	:	2205 OAK RIDGE RD
Second Line	:	SUITE CC
City	:	OAK RIDGE
State	:	NC
Zip	:	27310-8728
Country	:	US
Telephone Number	:	336-441-8301
Fax Number	:	336-441-8302

Provider Business Practice Location Address
First Line	:	2205 OAK RIDGE RD
Second Line	:	SUITE CC
City	:	OAK RIDGE
State	:	NC
Zip	:	27310-8728
Country	:	US
Telephone Number	:	336-441-8301
Fax Number	:	336-441-8302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	07/09/2014

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