Healthcare Provider Details

I. General information

NPI: 1194827287
Provider Name (Legal Business Name): CHARLES K MORIN D.M.D.,M.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CENTRAL AVE BLDG 2
BILLINGS MT
59102-8626
US

IV. Provider business mailing address

2900 CENTRAL AVE BLDG 2
BILLINGS MT
59102-8626
US

V. Phone/Fax

Practice location:
  • Phone: 406-656-6100
  • Fax: 406-281-8025
Mailing address:
  • Phone: 406-656-6100
  • Fax: 406-281-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number100069770A
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5443
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11501
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11501
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: