Healthcare Provider Details

I. General information

NPI: 1477627032
Provider Name (Legal Business Name): LANI COOK DEIBERT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LANI COOK MCLANE

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N 19TH AVE STE H
BOZEMAN MT
59718-3920
US

IV. Provider business mailing address

289 DEREK WAY
BOZEMAN MT
59718-7304
US

V. Phone/Fax

Practice location:
  • Phone: 406-585-8701
  • Fax:
Mailing address:
  • Phone: 406-570-6913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number#2271
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-4032
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2271
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: