Healthcare Provider Details

I. General information

NPI: 1689947269
Provider Name (Legal Business Name): SHADRACH ROUNDY BARNEY L.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 9TH ST W STE 4
COLUMBIA FALLS MT
59912-3858
US

IV. Provider business mailing address

218 TERRACE RD
KALISPELL MT
59901-7432
US

V. Phone/Fax

Practice location:
  • Phone: 406-892-0700
  • Fax:
Mailing address:
  • Phone: 406-885-0184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number28
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: