Healthcare Provider Details

I. General information

NPI: 1568163871
Provider Name (Legal Business Name): KALLIE S WHITE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KALLIE S ZINNE RDH

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S 27TH ST
BILLINGS MT
59101-4227
US

IV. Provider business mailing address

123 S 27TH ST
BILLINGS MT
59101-4227
US

V. Phone/Fax

Practice location:
  • Phone: 406-247-3333
  • Fax: 406-247-3334
Mailing address:
  • Phone: 406-247-3333
  • Fax: 406-247-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number23683
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: