| NPI | 1508657545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADY KELLER Owner 406-671-2483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 122300000X Dentist |
| 1223P0300X Dentist, Periodontics | |
| 1223P0700X Dentist, Prosthodontics | |
| 1223X2210X Dentist, Orofacial Pain | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology | |
| 126800000X Dental Assistant | |
| 261QD0000X Clinic/Center, Dental | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223E0200X Dentist, Endodontics | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery | |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality | |
| 1223G0001X Dentist, General Practice | |
| Enumeration Date | 2025-05-16 |
| Last Update Date | 2025-11-24 |