Healthcare Provider Details

I. General information

NPI: 1538604400
Provider Name (Legal Business Name): TMJ & SLEEP THERAPY CENTRE OF MONTANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 SOLLID RD
CONRAD MT
59425-9222
US

IV. Provider business mailing address

1929 SOLLID RD
CONRAD MT
59425-9222
US

V. Phone/Fax

Practice location:
  • Phone: 406-952-0154
  • Fax: 406-952-0153
Mailing address:
  • Phone: 406-952-0154
  • Fax: 406-952-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1880
License Number StateMT

VIII. Authorized Official

Name: DR. SCHUYLER A VANDYKE
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 406-952-0154