| NPI | 1942483524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL LEONARD TIEDE Business Manager 406-541-7334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MT MT2151) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT MT2229) |
| 1223G0001X Dentist, General Practice (Licence: MT MT2212) | |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2014-01-31 |