Healthcare Provider Details

I. General information

NPI: 1285023234
Provider Name (Legal Business Name): FRENCHTOWN DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16350 BECKWITH ST
FRENCHTOWN MT
59834-9812
US

IV. Provider business mailing address

PO BOX 1048
FRENCHTOWN MT
59834-1048
US

V. Phone/Fax

Practice location:
  • Phone: 406-626-4337
  • Fax: 406-626-3357
Mailing address:
  • Phone: 406-626-4337
  • Fax: 406-626-3357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5911
License Number StateMT

VIII. Authorized Official

Name: DR. JENNIFER DAWN SANDERS
Title or Position: DENTIST - OWNER
Credential: D.M.D.
Phone: 406-626-4337