Healthcare Provider Details

I. General information

NPI: 1669489530
Provider Name (Legal Business Name): CHAD EDWARD KRISKOVICH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 GRAND AVENUE SUITE D
BILLINGS MT
59102
US

IV. Provider business mailing address

2700 GRAND AVENUE SUITE D
BILLINGS MT
59102
US

V. Phone/Fax

Practice location:
  • Phone: 406-259-5700
  • Fax:
Mailing address:
  • Phone: 406-259-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2129
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: