| NPI | 1538383591 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY LAURA SIMMONS Dentist And Owner 406-375-1192 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2141) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 2142) |
| 124Q00000X Dental Hygienist (Licence: MT 749) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-08-22 |