Healthcare Provider Details

I. General information

NPI: 1275210627
Provider Name (Legal Business Name): BOZEMAN DENTURE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2149 DURSTON RD STE 32
BOZEMAN MT
59718-2805
US

IV. Provider business mailing address

308 EASTLAKE CIR
BILLINGS MT
59105-3536
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-6569
  • Fax:
Mailing address:
  • Phone: 406-671-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN WAYNE BENNION
Title or Position: MANAGER
Credential: DDS, MD
Phone: 406-671-0496