| NPI | 1255620928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRANT MATTHEW WISWELL Owner/Surgeon 406-552-9970 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: MT 2433) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2011-04-04 |