| NPI | 1073646543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM GENDROW Office Manager 406-728-9442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2024) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-08-22 |