| NPI | 1154656361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN AARON HICKS President 406-216-5273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2293) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2009-10-19 |