Healthcare Provider Details

I. General information

NPI: 1326108986
Provider Name (Legal Business Name): DENNIS R LACEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5872 EASTSIDE HWY
FLORENCE MT
59833-6942
US

IV. Provider business mailing address

5872 EASTSIDE HWY
FLORENCE MT
59833-6942
US

V. Phone/Fax

Practice location:
  • Phone: 406-273-6266
  • Fax: 406-273-2911
Mailing address:
  • Phone: 406-273-6266
  • Fax: 406-273-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1807
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: