| NPI | 1922103597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WAYNE BENNION Owner 406-655-2373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: MT 5246) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-08-22 |