| NPI | 1508657545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADY KELLER Owner 406-671-2483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| 1223P0700X Dentist Prosthodontics | |
| 1223X2210X Dentist Orofacial Pain | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| 261QS0112X Clinic/Center Oral and Maxillofacial Surgery | |
| 1223X0008X Dentist Oral and Maxillofacial Radiology | |
| 1223D0004X Dentist Dentist Anesthesiologist | |
| 1223G0001X Dentist General Practice | |
| 1223P0106X Dentist Oral and Maxillofacial Pathology | |
| 126800000X Dental Assistant | |
| 261QD0000X Clinic/Center Dental | |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223E0200X Dentist Endodontics | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| Enumeration Date | 2025-05-16 |
| Last Update Date | 2025-09-03 |