Healthcare Provider Details

I. General information

NPI: 1982907242
Provider Name (Legal Business Name): BRIDGE CREEK DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 HENRY CHAPPLE ST STE 5
BILLINGS MT
59106-1865
US

IV. Provider business mailing address

525 HENRY CHAPPLE ST STE 5
BILLINGS MT
59106-1865
US

V. Phone/Fax

Practice location:
  • Phone: 406-652-1600
  • Fax: 406-652-1205
Mailing address:
  • Phone: 406-652-1600
  • Fax: 406-652-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLE B. WASSMER
Title or Position: OWNER
Credential: D.D.S
Phone: 406-652-1600