Healthcare Provider Details

I. General information

NPI: 1205697877
Provider Name (Legal Business Name): GALLATIN VALLEY DENTURE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 04/03/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2149 DURTSTON RD SUITE 32
BOZEMAN MT
59718
US

IV. Provider business mailing address

2149 DURTSTON RD SUITE 32
BOZEMAN MT
59718
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State

VIII. Authorized Official

Name: ANNIE HULL
Title or Position: OWNER
Credential: LD
Phone: 406-586-6569