| NPI | 1710652938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA BLANTON-DICKENS Member 406-755-6014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2021-08-10 |