Provider Demographics
NPI:1710458732
Name:STEPHEN G OLMSTEAD III, DMD, PA
Entity Type:Organization
Organization Name:STEPHEN G OLMSTEAD III, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-270-0728
Mailing Address - Street 1:16717 US HIGHWAY 17 N STE 224
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3497
Mailing Address - Country:US
Mailing Address - Phone:910-270-0728
Mailing Address - Fax:910-270-8702
Practice Address - Street 1:16717 US HIGHWAY 17 N STE 224
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3497
Practice Address - Country:US
Practice Address - Phone:910-270-0728
Practice Address - Fax:910-270-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty