| NPI | 1982839890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELGIN WADE WILDE Dentist 406-294-2900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2218) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2009-05-20 |