Provider Demographics
NPI:1922447762
Name:OLMES, MATTHEW PHILIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PHILIP
Last Name:OLMES
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 1:271 RIGHTERS FERRY RD
Mailing Address - Street 2:APT. 2
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1718
Mailing Address - Country:US
Mailing Address - Phone:570-573-1111
Mailing Address - Fax:
Practice Address - Street 1:61 W CHELTEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2701
Practice Address - Country:US
Practice Address - Phone:215-713-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0395161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice