Healthcare Provider Details

I. General information

NPI: 1770240806
Provider Name (Legal Business Name): WLSI LEGACY SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 GRAND AVE STE 8
BILLINGS MT
59102-6258
US

IV. Provider business mailing address

3737 GRAND AVE STE 8
BILLINGS MT
59102-6258
US

V. Phone/Fax

Practice location:
  • Phone: 406-248-2669
  • Fax: 406-720-7759
Mailing address:
  • Phone: 406-248-2669
  • Fax: 406-720-7759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM WINTERHOLLER
Title or Position: OWNER
Credential: DDS
Phone: 406-248-2669