| NPI | 1407301872 |
|---|---|
| Doing Business As | GLACIER ORAL AND MAXILLOFACIAL SURGERY |
| Entity Type | Organization |
| Authorized Contact | PAMELA S ROBERTSON President/Chief Executive Officer 406-752-1724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MT 11198) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2017-10-04 |