MEDICARE: MONTE C. STEVENS DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1063235364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTE C. STEVENS DDS PC

Provider Business Mailing Address
First Line	:	223 N MAIN ST
Second Line	:
City	:	PLENTYWOOD
State	:	MT
Zip	:	59254-1843
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 N MAIN ST
Second Line	:
City	:	PLENTYWOOD
State	:	MT
Zip	:	59254-1843
Country	:	US
Telephone Number	:	407-765-2700
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	LAMONT STEVENS
Credential	:	DDS
Telephone Number	:	406-839-3148

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	12/20/2024

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