| NPI | 1215357397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA IVIE Billing Manager 406-702-1303 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MT 2171) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2024-02-29 |