Provider Demographics
NPI:1760059265
Name:OLMSTEAD, ALEXANDER TUBBS
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:TUBBS
Last Name:OLMSTEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-5233
Mailing Address - Country:US
Mailing Address - Phone:385-319-6131
Mailing Address - Fax:
Practice Address - Street 1:220 3RD AVE STE 204
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3554
Practice Address - Country:US
Practice Address - Phone:406-262-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist