| NPI | 1801093463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WAYNE BENNION President 406-655-0170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: MT 1516) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2007-10-18 |