| NPI | 1225485998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE CLAY CFO 406-862-1010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MT d2274) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT d1682) |
| 122300000X Dentist (Licence: MT d1887) | |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2016-05-23 |