| NPI | 1710133418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID GRAHAM WELTON Owner 406-538-2347 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MT 2286) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 2327) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2010-05-26 |