Healthcare Provider Details

I. General information

NPI: 1497540777
Provider Name (Legal Business Name): MOOS DENTAL OF MONTANA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 06/23/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W KOCH ST STE 1
BOZEMAN MT
59715-4148
US

IV. Provider business mailing address

379 HILLSDALE RD
BELGRADE MT
59714-9377
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-4559
  • Fax:
Mailing address:
  • Phone: 715-495-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY MOOS
Title or Position: CEO
Credential:
Phone: 715-495-5131