| NPI | 1396828711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA M LILLY President Of Corporation 406-862-8180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 1900) |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2020-08-22 |