Healthcare Provider Details

I. General information

NPI: 1902323421
Provider Name (Legal Business Name): KRISTIN ANN GORDER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN ANN LEMM

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 07/21/2022
Certification Date:
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 Number1003
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: