| NPI | 1043686892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCHUYLER A VANDYKE Dentist/Owner 406-952-0154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MT 1880) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 1880) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2015-08-17 |