| NPI | 1114187184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL-MARIE STEELEY CEO 406-500-2050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2021-08-17 |