Provider Demographics
NPI:1508023946
Name:OLMSTED, MATTHEW JOHN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOHN
Last Name:OLMSTED
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2205 OAK RIDGE RD
Mailing Address - Street 2:SUITE CC
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-8728
Mailing Address - Country:US
Mailing Address - Phone:336-441-8301
Mailing Address - Fax:336-441-8302
Practice Address - Street 1:2205 OAK RIDGE RD
Practice Address - Street 2:SUITE CC
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-8728
Practice Address - Country:US
Practice Address - Phone:336-441-8301
Practice Address - Fax:336-441-8302
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8582122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919809Medicaid