Healthcare Provider Details

I. General information

NPI: 1518320118
Provider Name (Legal Business Name): RECTOR ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N 10TH AVE
BOZEMAN MT
59715-3203
US

IV. Provider business mailing address

101 N 10TH AVE
BOZEMAN MT
59715-3203
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4218
License Number StateMT

VIII. Authorized Official

Name: DR. JEFFREY RECTOR
Title or Position: OWNER
Credential: DDS
Phone: 406-208-2085