Healthcare Provider Details

I. General information

NPI: 1649322777
Provider Name (Legal Business Name): BIG SKY ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3997 VALLEY COMMONS DR STE B
BOZEMAN MT
59718-5617
US

IV. Provider business mailing address

3997 VALLEY COMMONS DR STE B
BOZEMAN MT
59718-5617
US

V. Phone/Fax

Practice location:
  • Phone: 406-582-1515
  • Fax: 406-582-1919
Mailing address:
  • Phone: 406-582-1515
  • Fax: 406-582-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2014
License Number StateMT

VIII. Authorized Official

Name: MRS. JEFFERY MICHAEL HAMLING
Title or Position: OWNER
Credential: DDS MS
Phone: 406-582-1515