Healthcare Provider Details

I. General information

NPI: 1417873373
Provider Name (Legal Business Name): YELLOWSTONE ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S 29TH AVE
BOZEMAN MT
59718-4220
US

IV. Provider business mailing address

1150 S 29TH AVE
BOZEMAN MT
59718-4220
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-1811
  • Fax: 406-585-0295
Mailing address:
  • Phone: 406-587-1811
  • Fax: 406-585-0295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER CARLSON
Title or Position: ORTHODONTIST
Credential: DMD, MS
Phone: 406-587-1811