| NPI | 1164935573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDI M TRUESDELL Office Manager 406-442-0282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2455) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: MT 2455) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2018-11-15 |