Healthcare Provider Details

I. General information

NPI: 1841356094
Provider Name (Legal Business Name): BERT WELCH WINTERHOLLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 CENTRAL AVE STE L8
BLGS MT
59102-6686
US

IV. Provider business mailing address

2675 CENTRAL AVE STE L8
BLGS MT
59102-6686
US

V. Phone/Fax

Practice location:
  • Phone: 406-259-7438
  • Fax: 406-259-9729
Mailing address:
  • Phone: 406-259-7438
  • Fax: 406-259-9729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1820
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: