Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist |
NPI | 1760059265 |
---|---|
Provider Name | Alexander Tubbs Olmstead |
First Address | Havre, MT 59501-5233 |
Second Address | Havre, MT 59501-3554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2021 |
Last Update Date | 04/06/2021 |