Healthcare Provider Details

I. General information

NPI: 1629324306
Provider Name (Legal Business Name): RIMROCK PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 ZIMMERMAN TRAIL SUITE 1
BILLINGS MT
59102-7652
US

IV. Provider business mailing address

1601 ZIMMERMAN TRAIL SUITE 1
BILLINGS MT
59102-7652
US

V. Phone/Fax

Practice location:
  • Phone: 406-248-3303
  • Fax: 406-248-3939
Mailing address:
  • Phone: 406-248-3303
  • Fax: 406-248-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADY S. KELLER
Title or Position: OWNER
Credential: DMD
Phone: 406-248-3303