| NPI | 1730209974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY CLARKE Dentist 406-652-5550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MT 1797) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2020-08-22 |