| NPI | 1639626518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE A FREDERICKSON Owner 406-222-6061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2104) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 2318) |
| 1223G0001X Dentist, General Practice (Licence: MT 1299) | |
| 1223G0001X Dentist, General Practice (Licence: MT 1835) | |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2016-09-08 |