| NPI | 1538604400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCHUYLER A VANDYKE Owner/Dentist 406-952-0154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 1880) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2016-12-30 |
| Last Update Date | 2022-05-19 |