MEDICARE: RAB DENTAL LLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1780229195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAB DENTAL LLC

Provider Business Mailing Address
First Line	:	306 E 1ST ST
Second Line	:
City	:	LAUREL
State	:	MT
Zip	:	59044-3049
Country	:	US
Telephone Number	:	406-633-4910
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 E 1ST ST
Second Line	:
City	:	LAUREL
State	:	MT
Zip	:	59044-3049
Country	:	US
Telephone Number	:	406-633-4910
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT ALLAN BRONECKI
Credential	:	DDS
Telephone Number	:	406-633-4910

Provider Enumeration Date	:	11/08/2019
Last Update Date	:	12/06/2021

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