Healthcare Provider Details

I. General information

NPI: 1306554589
Provider Name (Legal Business Name): KAYLYNN DEE SHELDON LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 MISSOURI AVE
BUTTE MT
59701-4752
US

IV. Provider business mailing address

7579 THEISEN RD
BELGRADE MT
59714-8129
US

V. Phone/Fax

Practice location:
  • Phone: 406-782-2900
  • Fax:
Mailing address:
  • Phone: 720-467-8409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number23792
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: