| NPI | 1043373012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERNADETTE L WILSON President 406-862-5656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: MT 11198) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2023-03-07 |