Healthcare Provider Details

I. General information

NPI: 1134850969
Provider Name (Legal Business Name): WICKS DENTAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 WICKS LN
BILLINGS MT
59105-4496
US

IV. Provider business mailing address

502 WICKS LN
BILLINGS MT
59105-4496
US

V. Phone/Fax

Practice location:
  • Phone: 406-248-7868
  • Fax: 406-248-1768
Mailing address:
  • Phone: 406-248-7868
  • Fax: 406-248-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LAIGHTON D JONES
Title or Position: OWNER
Credential: DMD
Phone: 406-248-7868