Healthcare Provider Details

I. General information

NPI: 1770051567
Provider Name (Legal Business Name): GLASGOW PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 US HIGHWAY 2 E STE A
GLASGOW MT
59230-2009
US

IV. Provider business mailing address

1601 ZIMMERMAN TRL STE 1
BILLINGS MT
59102-7652
US

V. Phone/Fax

Practice location:
  • Phone: 406-248-3303
  • Fax:
Mailing address:
  • Phone: 406-248-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KATIE MCELROY
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 406-248-3303