| NPI | 1376812982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INGRID S MCLELLAN Dentist 406-443-5526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MT 2317) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: MT 1556) |
| 261QD0000X Clinic/Center, Dental (Licence: MT 1557) | |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2011-12-28 |