| NPI | 1376730853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRANDA VAN DYKEN Office Coordinator 406-586-8727 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MT 1304) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2007-09-28 |