| NPI | 1427074053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF A DALEN Owner 406-862-4301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2175) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 1381) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2019-09-06 |