Healthcare Provider Details

I. General information

NPI: 1801093463
Provider Name (Legal Business Name): BILLINGS ORAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 S 32ND ST W SUITE B
BILLINGS MT
59102-6848
US

IV. Provider business mailing address

152 S 32ND ST W SUITE B
BILLINGS MT
59102-6848
US

V. Phone/Fax

Practice location:
  • Phone: 406-655-0170
  • Fax: 406-655-2271
Mailing address:
  • Phone: 406-655-0170
  • Fax: 406-655-2271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number1516
License Number StateMT

VIII. Authorized Official

Name: DR. JOHN WAYNE BENNION
Title or Position: PRESIDENT
Credential: DDS,MD
Phone: 406-655-0170