Healthcare Provider Details

I. General information

NPI: 1891830931
Provider Name (Legal Business Name): VERMON CRAIG BARNEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CRAIG BARNEY DDS

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 NORTH MAIN
BOULDER MT
59632
US

IV. Provider business mailing address

211 NORTH MAIN PO BOX 1366
BOULDER MT
59632
US

V. Phone/Fax

Practice location:
  • Phone: 406-558-5123
  • Fax: 406-225-3150
Mailing address:
  • Phone: 406-558-4123
  • Fax: 406-225-3150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1852
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: