Provider Demographics
NPI:1184207839
Name:OLMSTEAD, MICHAEL JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:OLMSTEAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 MAHARISHI CENTER AVE
Mailing Address - Street 2:BUILDING C UNIT 3
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556
Mailing Address - Country:US
Mailing Address - Phone:808-639-9422
Mailing Address - Fax:
Practice Address - Street 1:INDIAN HILLS COMMUNITY COLLEGE
Practice Address - Street 2:525 GRANDVIEW AVE.
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-0000
Practice Address - Country:US
Practice Address - Phone:641-683-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAFAC-40186122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice