| NPI | 1710523725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER RYAN WALLIS Owner 406-585-1120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2019-11-25 |