Healthcare Provider Details

I. General information

NPI: 1548391444
Provider Name (Legal Business Name): PHILIP G DRISCOLL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PHILIP GREGORY DRISCOLL D.D.S.

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLACKFEET COMMUNITY HOSPITAL GOVERNMENT SQUARE
BROWNING MT
59417
US

IV. Provider business mailing address

BLACKFEET COMMUNITY HOSPITAL P.O. BOX 760
BROWNING MT
59417
US

V. Phone/Fax

Practice location:
  • Phone: 406-338-6180
  • Fax:
Mailing address:
  • Phone: 406-338-6180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number4274
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: