| NPI | 1841648227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYRUS MICHAEL LARSON President 406-543-0300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MT 9630) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 1739) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2016-05-26 |