Healthcare Provider Details

I. General information

NPI: 1770748436
Provider Name (Legal Business Name): RUSSELL SCOTT HOMER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CENTRAL AVE, BLDG 1
BILLINGS MT
59102-6686
US

IV. Provider business mailing address

2900 CENTRAL AVE, BLDG 1
BILLINGS MT
59102-6686
US

V. Phone/Fax

Practice location:
  • Phone: 406-656-6100
  • Fax: 406-656-8726
Mailing address:
  • Phone: 406-656-6100
  • Fax: 406-656-8726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2312
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: