| NPI | 1205183852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL LEONARD TIEDE Business Manager 406-541-7334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MT 4170) |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2012-08-13 |