| NPI | 1861553117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY DAVID OLSEN President 406-542-7572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MT 2134) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2020-08-22 |