Provider Demographics
NPI:1407229917
Name:OLMSTED, BENNETT WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:WILLIAM
Last Name:OLMSTED
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 LOCUST ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2545
Mailing Address - Country:US
Mailing Address - Phone:413-584-3741
Mailing Address - Fax:
Practice Address - Street 1:51 LOCUST ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2545
Practice Address - Country:US
Practice Address - Phone:413-584-3741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18570921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice